The "Blocked" Cat

Feline Urinary Obstruction

Feline urethral obstruction (urinary blockage) is a medical emergency and requires immediate attention. If this condition is not recognized and treated promptly it becomes life threatening. Our staff frequently provides emergency treatment to cats who have developed a urinary obstruction; this is why we feel it is important that feline owners have information that can help them recognize signs of this emergency at home.  Dr. Sarah Brawdy, an Emergency Doctor here at VSES, has provided an informative article which discusses the condition, how it is treated, and how to care for your feline companion after they return home.

So what exactly happens if my cat becomes blocked?

First, let's get back to the basics and review some anatomy and physiology. The kidneys filter the blood, remove excess fluid from the body, and aid in maintaining normal electrolyte balance in the body. the kidneys make urine,which travels down the ureters to the bladder. During urination, urine leaves the bladder and hopefully into the litterbox via the urethra.

When a cat becomes "blocked" or develops a urethral obstruction, they are unable to pass urine through the urethra. As a result, the bladder becomes very large, hard, and painful. Pressure increases in the upper urinary tract and the kidneys are no longer able to filter metabolic waste products and maintain normal electrolyte balance. The build up of these waste products and electrolytes makes the cat feel sick. Left untreated, these changes will ultimately become life threatening. This is due to high potassium levels in the blood that eventually result in a slow heartbeat and can lead to cardiac arrest.

How do I know if my cat may be blocked?

Urethral obstruction is a diagnosis that is made on physical examination by you veterinarian. However, there are important signs that you can watch for at home. These signs may include the following:

• Straining to urinate and with the absence of urination or production of only tiny amounts
• Licking excessinvely at the genital region
• Attempting to urinate in inapproproate places
• Vocalizing or crying
• Vomiting
• Lethargy
• Hiding
• Anorexia 
• Acting painful and restless

You may only see some of these signs if your cat is blocked at home. Even if you do not see your cat straining, it is important to follow up with your veterinarian if any of these signs are noted.  

So what causes a urethral obstruction?
The signs of a urinary blockage may look very similar to signs of a urinary tract infection or feline idiopathic cystitis (inflammation of the bladder). On physical exam these cats will have a large, firm, and very painful bladder (peach to small orange in size). A normal bladder should be small and soft to semi-firm. There are many possible causes of a urinary blockage.
 These include the following:

• Crystals or 'sand" in the bladder resulting in a urethral plug
• Small bladder stones (uroliths) that have become stuck in the urethra
• Tumors within the bladder and/or urethra or outside the urethra
• Scar tissue causing a stricture (or narrowing of the urethra)
• Urethral spasms
• Muscos plug (mucous/inflammatory cells) resulting from inflammation of the bladder or urethra
• Blood clots

How do you treat a urethral obstruction? 
Immediate treatment involves stabilization and relieving the obstruction. This procedure may be uncomfortable and painful and is therefore done under heavy sedation or anesthesia.  A urinary catheter is passed into the urethra and is advanced into the bladder to relieve the blockage. Oftentimes, resistance is met at the site of the obstruction and any material  (stones, mucous, crystals) obstructing the urethra is flushed back into the bladder.  The urinary catheter is secured and connected to a urinary collection bag. Typically the urinary catheter is left in for 48-72 hours, depending on how the cat is doing and how sick they were prior to the procedure. Hospitalization following the unblocking procedure is important, especially in the patients that are really sick when they are diagnosed.  When a cat is blocked, the kidneys are unable to make urine normally. Once the blockage is relieved, the kidneys will reestablish urine flow. The kidneys begin to make urine very quickly in order to correct the metabolic abnormalities that have been going on.  Sometimes these cats will make large amounts of urine very quickly (post obstructive diuresis) and can become severely dehydrated if they are not on IV fluids.  While in hospital, they are also started on medications for pain; medications that help relax the urethra, and antibiotics if they have a concurrent urinary tract infection.  Prior to going home, the urinary catheter is removed in hospital and they are observed for several hours to make sure they are urinating normally. Dietary changes are typically recommended if the cat has crystals or small stones in the urine. These are prescription urinary diets that work to dissolve crystals (and help prevent reblocking in the future).  Surgery is often recommended to remove bladder stones if they are the underlying cause of the obstruction. Once your cat is discharged from the hospital, it is important to watch for signs that may indicate reblocking has occurred. If you have any questions about your cat’s urinary status or if your cat is showing any of the signs listed above, it is best to contact your veterinarian. 

  Written by Sarah Brawdy, DVM

Meet Friday!

Friday came to VSES back in January of 2015.
Friday, a 6 year old Burmese, was seen by her regular veterinarian because she had not been acting like herself. She was depressed and not eating. Her blood work showed that Friday was battling renal failure. Her veterinarian recommended that she transfer to VSES for continued care and support.

A feline's kidneys can stop working effectively over time as the cat ages. However, an acute onset of renal failure (brought on by trauma, toxins, shock, infections,etc.) or chronic kidney disease can be a serious issue. A cat's kidneys help manage blood pressure, remove waste from the blood, and make hormones and red blood cells.

When Friday was brought into the hospital in the beginning of the year, she transferred over to our Internal Medicine department, with Dr. Michael Koch, Diplomate ACVIM, for further diagnostics and treatment of her disease. The Internal Medicine team worked their magic to get her eating again and back to her normal self. After about a week of treatments in-hospital, Friday went home!

We were lucky enough to hear from Friday's mom recently. Here's what she had to say:

I wanted to let you know, Nov. 20 has passed. That was the 10 month anniversary of Friday’s hospitalization. She still seems to be doing fine. 

In August, she pushed out a screen, caught a chipmunk and brought it back to us. She is playful and active and, if you didn’t know she’s running on a wing and a prayer, you wouldn’t know she was sick. However much time she has left, she’s had a great year.

This Thanksgiving, we are thankful she’s still with us. Great job!

We love to hear updates from our clients and we hope that Friday, along with all of our past patients, are still living life to the fullest.

If your pet was ever treated by VSES, we would love to hear from you! Please feel free to send any pictures and updates to vsesoffice@gmail.com

Preparing for a Visit to a Veterinary Emergency Facility

A veterinary emergency facility is a hospital that provides 24-hour emergency veterinary services and care to critically ill patients. These facilities are staffed with a highly trained team--including veterinary specialists, emergency veterinarians, licensed veterinary technicians, trained animal care attendants, and a dedicated receptionist staff--who are available when you need them to assist you during your pet's medical emergency.Veterinary emergency clinics are typically open all day, every day (even on the holidays).

A visit to a veterinary emergency facility differs from a routine trip to your local veterinarian for many reasons; there are no scheduled appointments, wait times can be long, situations are emergent, and costs tend to be higher. Think of it as the veterinary medicine equivalent to a human emergency room. It can be a stressful and emotional time for pet owners (and pets alike), especially if you don't know what to expect. Here are some tips to help you during that stressful time if you decide to bring your pet to a veterinary emergency facility.

What is considered a medical emergency?
It can be hard to judge whether or not your pet is having a medical emergency. Some conditions are not emergencies and can wait to be seen by your veterinarian during regular working hours. The emergency veterinary facility will be happy to see your pet regardless of the condition, but with non-emergent causes you can expect longer wait times as well as a larger expense compared to what it would cost at your regular veterinarian. If your pet is not in critical condition, you can always call your veterinary emergency facility to see if they recommend bringing the animal in for treatment. Keep in mind, if your pet is experiencing any of the following true emergencies, they should be brought in immediately:

• Severe bleeding, or bleeding that doesn't stop within 5 minutes
• Choking, difficulty breathing, or nonstop coughing and gagging
• Bleeding from nose, mouth, rectum, coughing up blood, or blood in urine
• Inability to urinate or pass feces (stool), or obvious pain associated with urinating or passing stool
• Injuries to the eye(s)
• You suspect or know that your pet has eaten something toxic (such as antifreeze, xylitol, chocolate, rodent poison, etc.)
• Seizures and/or staggering
• Fractured bones, severe lameness or inability to move leg(s)
• Obvious signs of pain or extreme anxiety
• Heat stress or heatstroke
• Severe vomiting or diarrhea--more than 2 episodes in a 24-hour period, or either of these combined with any of the other problems listed here
• Refusal to eat or drink for 24 hours or more
• Unconsciousness

An emergency facility will focus on your pet's most life threatening medical conditions. The goal of the doctors and staff is to stabilize the patient, control the ailment and return your pet to a point where they are stable enough to return home and visit your regular veterinarian for further treatment and monitoring. Remember, emergency veterinary facilities do not typically deal with routine vaccinations or stable long-term conditions that are being monitored by your usual veterinarian. Don't worry, your emergency veterinary hospital will send any records from your visit to your usual veterinarian so that they can seamlessly take over case management when your pet has been discharged.


Where does my pet go after they have been triaged?

If your pet is truly having an emergency, the veterinarians will want to stabilize it as quickly as possible. Taking your pet into the treatment room, where all the equipment is located, will be the quickest and most efficient way of ensuring your pet gets the medical attention it needs.

Your veterinary emergency facility has staff that are trained specifically to hold and restrain animals so that procedures can be performed quickly and easily with minimal stress to your animal. This also makes it easier for the veterinarians to examine the patient. You may be wondering why you cannot follow your patient back to the treatment area. Well, interestingly enough, many animals are more cooperative and less anxious when they are not in the presence of their owners; it is for their safety, as well as your own.

Your veterinary emergency facility is filled with employees who are pet owners just like you--many of which have been sitting in the waiting room themselves at one point or another. They understand how stressful it can be to be away from your pet, waiting to hear from a doctor about your pet's condition. Please know that veterinary staff treat your pet like one of their own and your pet is in the best hands when you bring them to a veterinary emergency clinic.

Should I schedule an appointment?
Emergency facilities are open 24/7/365 and are prepared for truly emergent situations that need immediate care from the moment they walk through the doors. As most of these situations are unpredictable, making an appointment ahead of time is not expected or required. However, it can be beneficial to you and the hospital staff if you can call ahead to provide a "heads up" so that the hospital can be optimally prepared when you arrive.

Why do I have to wait?Similar to the happenings of a human emergency room, wait time varies between patients depending on the severity of your pet's illness. On arrival, each animal is triaged by a trained professional who will determine how soon your pet may need to be seen by the doctor. You can imagine that a pet who appears stable may be waiting longer than a pet who comes in that is unstable.

These are not the only factors that play into wait time, however; behind the doors there are a variety of patients who are critically ill or undergoing emergent procedures that are being treated while your pet waits up front. Rest assured, that your pet will be seen and treated as soon as possible. Many veterinary emergency facilities have a wonderful front desk staff who are more than willing to update you on the emergency status within the hospital while your pet is waiting. Do not hesitate to ask them questions!


Why is the cost so high?
When your pet becomes injured, or suddenly develops an acute, life threatening disease, he or she will need prompt emergency care. In addition to the initial emergency treatment, many days of intensive care may be needed for recovery.

When you visit a veterinary emergency facility, you can be assured that they have the most advanced equipment to care for your pet's ailments as well as a group of dedicated support staff and highly trained specialists that are are able to diagnose and treat the most critical and life-threatening emergencies. They do this around the clock, 365 days a year, so operation of this type of facility comes at a price.

The benefit to this type of facility is that your pet gets premium, around the clock monitoring and care when they need it the most. Staff at a veterinary emergency facility are always willing to talk with you about the condition of your pet and work with you on the best course of treatment for the well-being of your pet and you, the pet owner!

How can I prepare for a pet emergency?
A veterinary emergency is not something people are usually prepared for. Much like in human medicine, treatment during an emergency is not inexpensive. We, as humans, are lucky to have insurance to help us, but this is not readily available for our furry friends; however, you can be prepared for a pet emergency with a little creative planning:

• Become familiar with your local veterinary emergency clinic. Know their hours, location, and all policies (including their financial policies).
• Keep your pet's veterinary records in an easily accessible place in case you need to rush out the door with them. It is always a good idea to keep a copy of your pet's current vaccine history in the vehicle as well, in case you are traveling with your pet. 
• Make sure to have a leash and and/or a carrier ready for your pet in an easily accessible area to make transporting easy. Keep in mind that in a true emergency, your pet is going to be painful and typically more stressed than usual.
• Have a credit card with an available balance set aside for these types of emergencies or an untouched savings account.
• Look into pet insurance for your pet. You may have to provide the money initially, but you will be reimbursed a percentage later, reducing the long term cost
• Know what your financial limits are and be willing to consider euthanasia as a last option if the level of care you can afford will not permit a humane recovery and reasonable quality of life for your pet.

The bottom line is that every veterinary emergency facility is stocked with highly trained individuals who specialize in serving animals and the people who love them. They provide support to the local veterinary community at any time of the day or night. Even though your visit to an emergency clinic may be emotional and stressful, know that your pet is receiving the highest standard of care when you need it the most.

Written by Jocelyn Wichtel, DVM