8. Young male cat passes blood in the urine (haematuria)

"My cat passes blood in the urine today," the woman in her 40s brought in a 1.5-year-old male cat for neutering. "Can you neuter him today?"

"If your cat is passing blood in the urine, he should be treated for this serious problem first. He is not healthy and may die if he is neutered" I said as the cat was presenting the symptom of haematuria (blood in the urine).

HISTORY & GENERAL EXAMINATION
I palpated the bladder. It was half the size of the tennis ball. His penile tip was red due to licking. He was still active, eating and drinking.

I asked: "Did your cat have difficulty in peeing or peeing in small amounts in the litter box?"

The woman said: "For the past week, he pees anywhere in the apartment." This cat was avoiding the litter box as he associated his pain in peeing to the litter box. The owner thought he had started urine-spraying and wanted me to neuter him immediately. There were two other cats in the apartment and he could be marking his territory as an intact male. Stress in living with other cats is said to be a cause of haematuria. So the owner wanted him neutered to prevent urine spraying but she did not say so.

"Do you feed dry food to your cat?" I asked.
"Yes, all my 3 cats eat dry food."

TREATMENT
The cat was still active and eating. He had no fever. His bladder was swollen on palpation. He was less than two years old but he could still be suffering from FLUTD (feline lower urinary tract disorder). Dysuria (difficulty in urination) and haematuria (blood in the urine) were the symptoms. This cat has a case of FLUTD.

CAUSE
More than 60% of the FLUTD have unknown causes and are said to be idiopathic. 20% of the cases are attributed to bladder stones. Bladder and kidney tumours and abnormalities of the urinary tract are unlikely in this young cat. Bacterial infection of the bladder or kidney is possible. Stress is said to be a factor in FLUTD and this male cat was stressed in that 2 other cats in the apartment occupied part of his turf.

TREATMENT
1. Drugs
I injected an antibiotic, an anti-spasmodic and steroidal anti-inflammatory SC and waited for one hour. The cat did not pee but the bladder had swollen much bigger. In some cases, these drugs worked when the cat went home and no further procedures are done. But this cat has passed blood in the urine and was in a more serious condition of FLUTD. He might die from kidney failure if the urinary obstruction was not cleared today.

2. Relieve urinary tract obstruction.
I passed a catheter into the cat. It was difficult to be passed into the bladder at some point but after entering the bladder, fresh red blood shot out strongly like a firing gun. I directed the urine stream to the kidney dish and to a collection bottle. Around 200 ml of red blood was expressed and syringed out and a sample was taken for urinalysis. Pinkish gelatinous tissues also flowed out. The catheter was stitched to the prepuce at two places opposite each other (catheter has holes, see picture).

3. The cat was given domitor 0.1 ml IV sedation. The catheter emptied his bladder of urine. You will note that cat urinary catheters have a very small hole at its tip. This would be OK for normal urine. But the cat with FLUTD had gelatinous mucosal plugs inside the bladder.

TIP: I took out the catheter and cut a bigger hole at its tip so that the mucous plug from the bladder mucosa can get in and be flushed out with the normal saline. I used a 20-ml syringe to pass normal saline into the bladder to irrigate the mucosa of the bladder. I could see pinkish plugs being passed out as I took out the syringe. After another 100 ml of normal saline, the bladder passed out clear saline.
An e-collar was given. The cat was given a slow IV saline drip for the next 24 hours.

4. FURTHER TREATMENT
Another two irrigations of the bladder the next day. The cat was warded for two days.

5. TESTS
5.1 BLOOD TEST for white cell count (infection)
5.2 URINE TEST for crystals (struvite or calcium oxalate), protein (kidney disorder) and bacteria (infections).
5.3 DIPSTICK TEST showed a high urinary pH and lots of blood.
X-rays or ultrasound (bladder stones) and IVP (Intravenous Pyelogram) tests are not done at this stage to save on costs. If FLUTD recurs, these tests may be done.

CONCLUSION
The cat is being warded and observed. No dry cat food. Canned food, prescription canned food or home-cooked food is recommended. Prescription canned food for cats with struvite or calcium oxalate crystals (pending lab results) would be recommended. Repeated bladder irrigations to clear the gelatinous plugs from the bladder for the next 2 days and no dry cat food are a key to success in the management of this case. Owners who would not give the vet the opportunity to do it by taking the cat home on the same day may find recurrence of FLUTD.

TIP: A follow-up urinary pH test every month is advised but few cat and dog owners of cats or dogs with urinary tract disorders or stones will do it. If the urine is highly alkaline, acidify the urine for 1-2 months and give anti-struvite or anti-oxalate canned cat food. Give home-cooked food as an alternative with plenty of water for drinking. No dry food to be fed.

Different cats are treated differently as not all cases have blood in the urine. It is best to consult your vet rather than do self-treatment in FLUTD.



Pictures are at www.toapayohvets.com, goto "CATS"

7. A forgetful veterinary intern?

Theresa, my veterinary intern placed the Burmese cat on the electronic weighting platform, looked at the digital reading in the green-window and said: "2.6 kg". A couple consulted me about the cat pawing her mouth recently.

"Are you sure?" I carried the 7-year-old spayed female Burmese cat. She had a compact body and was well fed. I would be putting her under anaesthesia to do dental work and from my experience, this cat would be heavier.

Mrs Thiele, a tall slim Caucasian lady who would have brought the cat to other veterinarians previously said: "The cat is heavier than that."

"Weigh the cat again," I instructed Theresa. This was a quiet cat and I was much surprised that Theresa could make a mistake. I said: "The cat may be 3.6 kg in weight." The girl who would be studying veterinary medicine in Oct 2010 took the cat from me and put the cat on the weighing platform. "3.6 kg," Theresa said. Mr and Mrs Thiele did not comment and I hope they would be forgiving.

This was a serious mistake which I did not expect Theresa to make at all. This 18-year-old girl had Grade As in her A-level examinations, except for a Grade B in Chinese. Her grades were impressive and she was accepted by a university in the United Kingdom. She was doing internship as the University wanted proof that she had seen at least 2 weeks veterinary practice but she had completed nearly two months.

Having interns can be damaging to the professionalism of the practice when they made such mistakes. The clients just go elsewhere the next time or bad mouth the practice. This is one reason why one big veterinary practice in Singapore does not bother with interns. Nowadays I qualify interns strictly before I accept them. They need to be top in their studies and be accepted to study veterinary medicine. Yet this incident happened. Why? I asked Theresa for an explanation. She said: "I saw 3.6 kg but I said 2.6 kg." This answer was mysterious to me. Was she forgetful?

As for the Burmese cat, Mr Thiele was very happy when I phoned him the next day. He said that the cat was normal and eating. At the consultation, Mr Thiele had observed that the cat was pawing her right side of the mouth but Mrs Thiele said: "The cat put her paws in the left side of the mouth as well."

I injected a mixture of 0.1 ml xylazine 2% and 0.4 ml ketamine in a syringe IM. This sedated the cat for dental scaling. The cat had two long ulcers at the back of the tongue (see pictures) as well as periodontal disease in the side teeth (premolars and molars). Since the cat uses the side teeth for cutting instead of grinding food as in most mammals, it is possible that the cat's side teeth cut into the back half of the tongue, causing two red linear ulcers (see pictures).