If you have not read Part 1 yet, you can read it here: My Experience: Cat Cystotomy & Complications – PART 1 DIAGNOSIS and My Experience: Cat Cystotomy & Complications – PART 2 INITIAL SURGERY
Before I start, I’d like to acknowledge that the subject of veterinary medicine is far from what my blog is generally about. I am not educated in veterinary medicine and what is stated is my experience, as well as my interpretations. I will not be using the names of the veterinary offices. Instead, I will use “Vet 1” as my primary vet and “Vet 2” as my secondary vet. Any veterinary professionals mentioned have had their names changed for the purpose of this/these post(s).
While I was doing research, it was extremely difficult to find people who have written about their experiences regarding surgery in a cat and have really been detailed about it. I want to help. This is a very emotional experience and I want people in the same situation to have confidence in their vets and surgeons. I also want them to feel less alone in their journey.
This was supposed to be a routine, straight-forward surgery, until a rare complication was discovered.
Part 3 needs a trigger warning as some individuals are extremely sensitive to subjects regarding death & dying. There are no gruesome details or pictures. Please read the paragraph following the end of this experience/story.
DAY 8 FRIDAY 08/23 CONTINUED…
Dr. B was stammering, having a hard time beginning what he was trying to explain to me. He started to draw a diagram of the kidneys, bladder, and urethra so I could better understand what he was trying to say. “She has free fluid in her abdomen,” he begins. He continues to explain that he is positive that the fluid was urine, resulting in Uroabdomen. He explains that there are 3 ways that this could have happened.
Possibility #1: One or both of the ureters have disconnected from the bladder. If it is only one, they can save her life by removing her kidney. She would be able to live with 1 kidney.
Possibility #2: The incision in her bladder from the original cystotomy has opened, leading to the bladder emptying into her abdomen. This would also be simple to fix, as they would just suture her incision site again, but better so it holds together and heals.
Possibility #3: There is a hole/tear in the urethra. While a cat may still urinate somewhat normally, this also leads to urine leaking into subcutaneous tissues causing inflammation and, eventually, necrosis. Urethral tears are extremely rare, occurring in less than 1% of cats with lower urinary tract disease (source). Often times, this is fatal.
Hoping for possibility #2, or even #1, gave me hope that she will recover from all of this. Dr. B explained that they wouldn’t be able to determine the cause until they do exploratory surgery, as well as empty the urine in her abdomen. Dr. B also cautioned me about the possibility of Lotus not making it through surgery. Because of this, I was able to spend some time with her to say goodbye….just in case.
I went home to wait for an update. Two hours later, Dr. B called. Lotus had made it through her surgery and was still drowsy, but waking up. Thank goodness!
Dr. B preceded to tell me that Lotus has a urethral tear. The urethra in a cat is so small, so they did their best to close it up in a “modified technique”. He explained that her bladder stones potentially weakened the wall of her urethra and bladder, leading to an easy tear. Dr. B assured me that no surgical tools would have been in the area of the tear during her original cystotomy, so it was not likely that it was an accidental cut. Honestly, I didn’t know what to believe anymore.
Because Vet 1 is open during normal business hours, they transferred Lotus to Vet 2 for better care and observation. Vet 2 had significantly extended hours, sometimes open until midnight.
DAY 9 SATURDAY 08/24/19
Today, I picked Lotus up from Vet 1 to drive her to Vet 2 for her transfer. I was so happy to see her and I was happy to see her meowing so much while in her carrier. She’s usually quite a whiner during car rides and vet visits, so this was a good sign. I dropped her off and returned home. A couple of hours later, her surgeon from her original cystotomy, Dr. M, called to update me. Lotus was still showing no interest in food, but he wasn’t that concerned considering she had surgery just 24 hours before. He let me know that an ultrasound was performed and that there was no free fluid in her abdomen. I was thrilled to hear that. He did caution me, though, that the emergency surgery was not routine, it was a “modified technique”, and he was unsure how it would hold. To keep her bladder as stress-free as possible in order to heal, they kept a catheter in her. The morning vet would give me a call tomorrow to let me know how Lotus did overnight.
DAY 10 SUNDAY 08/25/19
The morning vet at Vet 2, Dr. A, gave me a call in the late morning. An ultrasound was performed this morning and, unfortunately, they did find free fluid in Lotus’s abdomen, but they were unsure if it was urine. Dr. A let me know that Lotus was still not eating and that she would try to give her an appetite stimulant later in the day. Next, we discussed the blood chemistry. Lotus’s creatinine level was at approximately 8.0 mg/dl the previous night and it has since increased to approximately 10.0 mg/dl. To give you perspective, normal creatinine levels in cats are below around 2.0 mg/dl. A creatinine level of 5.5 mg/dl indicates kidney failure. Dr. A preceded to tell me that Lotus was indeed in acute kidney failure and they were unsure if she would survive it or not. She explained that she has seen cats recover from similar circumstances, but she has also seen many perish. Lotus was alert, meowing, and moving around so her and I decided that we would see how she does in the next 24 hours before making a decision that is irreversible.
That night, I called Vet 2 to see how Lotus was doing and if she had eaten. Dr. P, the vet that saw Lotus at an emergency appointment the previous Sunday, advised me that they were about to do another ultrasound and blood chemistry, and they would call me back with the results. When Dr. P called back, she informed me that Lotus was still alert, but not moving much and not meowing like her normal self. She continued on to tell me that her abdomen has filled with fluid significantly since the morning. Before I were to make any decision, I wanted to judge Lotus’s behavior for myself. At 10PM, I drove to the vet to see Lotus. Indeed, she didn’t move much at all and wasn’t meowing, but was looking around the room and responding to pets and verbal commands like “treat” and “hungry”, the two words she knows very well. I brought her favorite treat, a Squeeze Up, and was able to feed her. She ate most of it and also had some broth from Dr. P. After discussing Lotus’s chances of survival, her quality of life, and any other possible interventions for her, I decided to end her suffering. Regardless of medications, fluids, emergency surgery, and tests, Lotus was not responding to treatment. She was too far in to kidney failure to recover from it.
It was an extremely difficult decision, as I didn’t want to give up hope or give up on her. After all, she was only 2 years old. She passed away in my arms, with her head lying in my hand, a couple of minutes after midnight. My sweet girl is gone. I went home with an empty carrier and a hole in my heart.
Judging by the original symptoms the previous Sunday at her emergency appointment and the worsening of her symptoms during the week, I suspect that the urine in her abdomen had been there for more than 3-5 days. Uroabdomen, when gone untreated, will lead to severe inflammation, infection, and necrosis. Personally, I do believe this could have been caught one week before during her emergency visit, but Dr. P never ran any tests nor mentioned the possibility of testing Lotus. If this were caught 1 week earlier, would Lotus have survived? I don’t know, but her chances at survival would have been much higher if it was found earlier.
My experience with my cat’s cystotomy, a very routine procedure, was a rare occurrence. Cystotomy surgeries are often successful and cats go on to live full lives afterwards. I am in no way telling you to avoid surgery for your precious four-legged buddy; it might be your best option for recovery. Instead, I want you to do your research and be armed with the information when visiting with the vet.
Ask questions, no matter how ridiculous. How long has the vet been performing the surgery? Who else will be touching your animal (technicians, doctors, surgeons, vet techs, etc.)? Most importantly, are they using the right catheter for the bladder and how experienced is the person guiding the catheter in? With a weakened urethra wall, there is very little room for error. A catheter needs to be inserted very gently, with little to no force. In Lotus’s case, Dr. P admitted that the catheter used was not the smallest one and was very rigid and inflexible. Dr. P was actually in the process of switching to a smaller, more flexible catheter when I came in to the office to see Lotus. Although rare, urethra tears are most commonly caused by catheters being inserted into the urethra/bladder. I am positive that Lotus’s complications resulted from the catheter(s), which is extremely upsetting to me because this is avoidable. Both Vet 1 and Vet 2 are some of the most highly rated vet offices in my city and this still occurred.
Please, if you are going through this or something similar with your pet, ask questions and research everything!
All I want for you and your pet is success and for you both to recover quickly and live happy lives together. Pets are SO important in some lives. Like many other pets, Lotus was emotionally supportive due to my struggles with major depression and generalized anxiety. I am so heartbroken to have lost her so quickly and I do not want this to happen to anyone else!