Blocked Cat

I finally worked my last official day at my old vet clinic yesterday (I start my new job Monday). And it was crazy busy-just the way I like it. The only thing to put a black cloud on my day was the emergency clinic transfer case first thing in the morning. See, it was a cat with a urethral obstruction.

Most vets don't mind these as emergencies-they are very rewarding to treat: cat comes in, is very, very sick, can't pee, you do bloodwork and find out they have post renal azotemia and some pretty screwy electrolytes, start on IV fluids (for approx 2-3 days), sedate them and use a urinary catheter to unblock them, the cat returns to normal, no worse for the wear (usually).

There are several reasons I don't like them. First of all, the course of treatment involves 24 hour care and usually 2-3 days of hospitalization, and they almost always happen (for me at least) on a Friday evening or saturday. That involves convincing the owner that the cat needs to be transferred for after hour care at the emergency clinic-many vet clinics do not have 24 hour care. And then I have to leave the case management up to the emergency clinic vets (nothing against them, but I like managing my own cases from start to finish-otherwise how will you learn from them?).

Secondly, although everything is usually straightforward, it still ends up being a very expensive emergency-and it truely is an emergency (if the cat is not treated, it WILL die a very painful death within 24-48 hours)-average cost for diagnostics, treatment and resolution of the problem ends up being between $500-$800 at least. And that's assuming everything goes smoothly. The cats that I have seen that block are more often than not owned by very nice people that haven't budgeted for such an expensive emergency. And there really aren't any ways to short-cut the treatment without compromising the patient.

Thirdly, cats that have obstructed once are more likely to re-obstruct at some point down the road. I really hate explaining to owners that yes, they've paid all this money to fix their cat, and it's likely they will have to pay it again, especially because the ones that reblock will always belong to the people that can't afford it (being sarcastic there). There is a surgical option for cats that have obstructed more than once, but it comes down to finances again-first time they block=$600, second time they block=$600, then surgery (on the second or third time they block)=$800 (give or take, depending on where you go).

Lastly, the cats that have urethral obstructions are usually of the aggressive persuasion (in my experience). Cats have this response where they can get lower urinary tract inflammation (like white cells, red cells, crystals, mucous, and sludge) due to stress. There has been and currently is a lot of research going into the problem of feline lower urinary tract inflammation and how to prevent it, but we don't have the answers yet. In short, evil cats are more likely to obstruct than nice cats because by nature they are more stressed out. And anyone who has ever had to try to keep an IV catheter +/- a patent urinary catheter in a cat that will eat you every time you open the cage door will know how difficult it can be to treat them.

So, back to my case....the cat's obstruction was relieved at the emergency clinic. Then it was transferred to me (on a Friday, and I will no longer be working at the clinic, so unable to provide the follow-thru care). For whatever reason, radiographs, bloodwork, or urinalysis were not performed the emergency clinic. When I received the case, the owner was already well over the pet budget for the month and could not afford any complications or transfer for overnight monitoring. The cat is not evil, persay, but has a grumpy temperament. Being a busy day, I ended up taking radiographs at the end of the day to scan for stones, and low and behold, I see "sand" in the bladder-making it likely this cat will reobstruct. After my restless night's sleep worrying about the cat hospitalized overnight unobserved with the "sand" in the bladder and the owner not having enough money to afford a re-obstruction, one of my colleagues took over the case this morning.

I guess it's all in a day's work for a veterinarian.