I was standing on top of a five foot tall berm of composting horse poop trying to decide if it had “cooked” enough to put in my raised garden beds when the call came through. “The local spay/neuter clinic called. Someone brought in a young, probably about a year old, male cat who is fully blocked and in trouble” “What’s his story?” I asked. “The woman who brought him in said she found him in a park running up to people meowing like he was asking for help.” That was unlikely. It does not fit with known cat behavior. More likely this was an owner who was making a frantic bid for help, even if it meant euthanasia. This cat was in a lot of pain. “The clinic says he’s in bad shape – his bladder is huge and hard - and recommends euthanasia but called us first,” the caller went on. This clinic is not set up to deal with these sorts of issues, but our usual full-service veterinary clinic is. Unfortunately, he was 30 minutes away from it, and I was 30 minutes from either of them. “No. Tell them not to put him down. I’m not close but find someone who can transport. I’ll call ahead and meet him there. Some cats have issues with their urine being the wrong pH which can cause crystals or stones. The most common form, struvite crystals, happen when the urine is not acidic enough. If caught in time, a change in diet can cause them to dissolve. The other, less common, problem is oxalate crystals or stones which happen when the urine is too acidic. These usually cannot be dissolved and removed surgically. No one knows for certain what causes them, and either kind can cause havoc in both male and female cats. They are particularly deadly in male cats – whether neutered or not. Anyone who has ever passed a bladder stone knows how painful that can be. What happens if it gets stuck part way down the tube? Although it can occur in females, the males are more at risk because their “tube” (urethra) is longer and narrower than the female’s urethra. If something gets stuck, it can block the urine which then backs up into the bladder. The longer it remains blocked, the larger, and harder, the bladder becomes. Untreated, it is always fatal. This is what had happened to Snoopy. And, judging from what the vet could palpate, it was reaching a critical point. Snoopy had arrived by the time I got to the clinic and had been taken to treatment. This
clinic is an “open” clinic, meaning the owner can stay with their pet all through the process, including watching surgery. As I walked in back they had just sedated him and were placing a urinary catheter to drain his bladder. Next they would admit him to the hospital and use IV fluids to put fluids into his veins and the urinary catheter to let the urine exit the bladder unimpeded. I call it “power washing the bladder.” I’m not sure they appreciate my euphemism, but I think it’s a decent portrayal of what is being done. Once everything is flowing well, they pull the urinary catheter out and see how the cat does. It is a process that takes several days and is very expensive. The clinic tests the urine – or the stones, if that is what they find – and determines if they are struvite or oxalate because that determines the next steps. Luckily, Snoopy had struvite crystals. He was put on a prescription diet to encourage his pH to stay on the slightly acidic side with the hope this would be the end of his problems. I wasn’t so convinced. It is unusual for this to happen to such a young cat. I talked it over with a couple of my vet-friends who worked there, and they agreed with me. Even so, this is the correct next-step, so we took it. He was discharged and went home with me. Two weeks later – on the special diet – he blocked again. I caught the signs quickly so we went in and repeated the process. Generally the procedure is to do this twice, and if it happens a third time, then consider a special surgery called a perineal urethrostomy aka PU. This is basically a “sex change” for the cat. It removes the narrow part of the tube and reroutes the upper, wider portion out of the body to make blocking less likely. But, Snoopy’s case was different. An ultrasound suggested he might have an abnormal narrowing (a stricture) high in the tube that was causing the problem. There were only two vets there who were willing to even attempt it because the stricture was higher than where they would usually cut.
“Well…we don’t really have a lot of choice. From what you are telling me, he is going to block again. We can’t unblock him every couple weeks for the rest of his life,” I said, looking at Snoopy in ICU while talking with one of my favorite veterinarians. He had proven himself a good surgeon and one who was willing to try things when options were limited. “Yep. But, I want you to know, I may get in there and realize it isn’t going to work,” he told me.
“Okay. Well, I’ll go in with you and if at any point you say it is a no-go, then we’ll let him go.” A couple hours later we were all in the operating room. As soon as he opened Snoopy up and located the problem he went to work. I was in there watching and we occasionally talked back and forth. He showed me where the problem was and said he thought it was worth a shot. However, once he started, if it didn’t work, there would be no going back. I told him to go ahead. He was very focused and, watching his facial expressions, I wasn’t sure how it was going. I kept silent – he was concentrating and the last thing he needed was me quizzing him. Occasionally he would tell me where he was in the process. Finally, he said “Okay, we’re done. I’m going to flush now.” That was the final test – would the re-routed urethra work? Seconds later he was beaming! “YES!!!!” he shouted with a fist pump. He was very enthusiastic when things went well! “So, uh, do you think, like, maybe we made the right decision?” I teased him. He made an appropriate retort.
Seven years later, Snoopy’s “plumbing” still works flawlessly! The advances that have been made in veterinary medicine in the past few decades are astonishing. We are grateful whenever we get the chance to draw on them and save a life like Snoopy.