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[Very Urgent] Advise on Cystotomy vs PU
My 8 year old cat (male, neutered, American short hair) was diagnosed with bladder stones and underwent a cystotomy in February 2024 to surgically remove the stones from the bladder. Unfortunately, the surgeon left behind 3-4 stones in the urethra during the surgery, which were later pushed back in the bladder. These stones blocked him again in May 2024 – he was unblocked via a catheter and the stones were pushed back into the bladder during catherization. He again got blocked a couple days ago and has been unblocked again via catherization with the stones pushed back in the bladder. The X-rays do not show formation of new stones in the last few months and the urinary analysis do not show any crystals.
We are considering three surgical options to remove the sones now: 1) cystotomy 2) PU 3) Cystotomy + PU. Please see X-rays after the cystotomy in February, the one from May and the one from last night and advise on the best course of treatment
Should my 15yo cant perform nasal polyps removal operation?
Good Afternoon Doctor.
I came across your Youtube video that you are performing Nasal Polyps removal operation to young cat.
My question is should my 15yo cat young enough to receive this operation.
Currently he is on Steroid and Yuan Bio medication but it is starting to wear-out.
Those medication worked great for the first month but now he is having discomfort in respiratory again.
My cat is not young but I would like to maintain the QOL of the cat and wanted to know if this helps.
If so, what will be the rough estimate and how long does she might have.
I know this is hard to speculate without actually seen the cat but just a ballpark will be appreciated
Thank you
T
Hello,
In my experience I have never seen a polyp in a cat this old. It is far more likely that this is a neoplastic mass (cancer) than a polyp. If you are concerned about your cats quality of life than I would do and consider doing anything and everything to alleviate her discomfort and try to improve her life.
Thank you for your quick response doctor,
Yes I was told he has a cancer, so I guess I misunderstood that tumor and polyps are different.
I guess too old for Chemo and radiation and surgery, what will be the appropriate to maintain the QOL ?
My vet told there aren’t much they can do.
I just feel helpless seeing cat in such a discomfort.
He is eating well, and very active as for now, but just breathing seem difficult sometimes.
Thank you
T
Hi Krista,
We had adopted two month old American Short Hair and got them all vaccinated at Petco plus got them Spayed/Neutered.
One of them, 2 years old Riley had a runny nose(Green Mucus) right from the beginning and later on the Vet at Petco mentioned that she has a Polyp and can’t be treated at their facility.
I need your help to find a vet that can perform Polyp removal surgery on my 2 year old female American short hair cat near Chicago, IL
It seems Riley has a very large Polyp or some type of mass that’s blocking her airway and food pipe; the vet tried to insert a tube for breathing and it couldn’t go through due to a large mass that is blocking it.
This Vet @ Westchester Animal Clinic in Porter, IN recommended a Specialist and is not optimistic that this polyp or mass can be removed through surgery and was proposing Euthanizing as an option which we didn’t agree.
Hello,
I apologize for the delay. Somehow I missed this one.
Call everyone and see if you can find someone who will anesthetize and look for a polyp behind the soft palate. Call all of the rescues, shelters and private veterinary clinics. Put out a plea on social media. Use all platforms to ask for help.
Keep me posted.
My cat had some secretion on his bum opening and it was definitely that anal sac smell I’ve experienced before. I’ve wiped it off, but wonder what to do if it persists, do I need to express them?
This just happened today and I haven’t noticed the smell or any issues until now. I’m hoping I just caught him after using the bathroom or something and he’s able to resolve it on his own but want to be ready if he can’t.
Hello,
I recommend that the vet check them. It can be an anal gland infection, abscess or mass. In some cases we can just empty them and then recheck in a few months. In other cases these should be checked more often and in rare cases we talk about surgically removing them.
I have two cats so I didn’t notice my cat is not eating. He’s very skinny. He refuses his favorite foods. He’s drinking water. He’s greenish looking poo around his anus. Old and dry. I tried to clean it.
We are on one income and cannot make it to the vet. What should I do?
Hello,
There is no way I can give honest and credible advice without advocating that this cat sees a vet asap. There are non profits that can provide financial assistance and some that even have a vet on staff to provide care. This cat needs an examination and some diagnostics.
Please call your local vets, shelters and rescue groups. Look for help on every local social media platform and keep asking for help. Start a go fund me. The best advice I can give if this.
We need more information to help you and your cat.
Please stay tuned. I am working on this very topic
A question for Krista Magnifico:
Hello! Hoping to get some advice on recommended next steps for my cat, Sammie, who is being evaluated for IBD vs. small cell lymphoma.
Sammie is 17 years old and is overall quite healthy! Throughout the time I’ve had her, she’s had a history of vomiting a ~once per week or two (sometimes more frequently). Vomit is usually clear, foamy. No other GI issues or health issues otherwise. She is active and energetic, and has not had any health issues until ~1 month ago when I noticed she stopped eating as much as she previously did. She stopped eating her dry food altogether, and seemed to become quite picky with her wet food. I initially thought her teeth may be bothering her because of the avoidance of dry food, so I brought her to the vet.
Vet found that she had lost a couple of pounds, unintentionally. Based on presenting symptoms, vet thought she might have a GI pathology so ordered an abdominal U/S:
Ultrasound, Abdominal Study Outcome:
Kidneys: overall normal size but mild reduction in detail and small mineral foci. Trace pylectasia noted w/out ureteral disension.
GI: Avg SI thickness normal. Mild corrugation is noted in some regions and some ileus (luminal fluid distension up to 4 mm w/ reduced
peristalsis) noted w/out obstruction. No discrete abnormalities appreciated throughout the small intestines.
Caudal abdominal nodes are prominent to mildly enlarged and rounded w/ smooth texture. One irregular cystic structure noted near right
kidney. The mesentery around the ileus segments is mildly hyperechoic.
A:
Intestines most consistent w/ enteritis
Nodes: r/o reactive vs other
Cystic strucure: r/o benign mesenteric vs inflamed node
Kidneys have evidence of chronic disease.
Here are her prior labs:
PRIOR LABS:
7/15/24: Wt loss 0.28 lb; PCV: 40/7.6; Chem18: BUN 41, creat 1.7, K+ 4.3, phos 4.2
U/A: USG 1.019, pH 6.0, rare wbc/rbc; no bact/cryst; cobalamin: 437; folate: 11.2
2/13/24: Wt loss 0.8 lb; CBCcomp: hct 44, diff wnl (clots in sample; rec. resubmit)
Chem25: BUN 40, creat 1.3; T4: 2.8; SDMA <10
U/A: USG 1.025, pH 6.0, rare wbc, no rbc/bact/cryst, rare fine gran casts.
1/19/23: Wt loss 0.4 lb; CBC: (hct 40, diff wnl); Chem25: (BUN 32, creat 1.3)
T4: 1.8; U/A: USG 1.051, pH 6.5, 1+ prot, rare wbc, no rbc/bact/cryst
11/19/21: CBC: (hct 46, diff wnl); Chem: (BUN 34, creat 1.5); T4. 1.9; DGGR lipase 9
U/A: USG 1.053, pH 7.5, rare amorph. crystals, no wbc, no rbc
6/17/22 Wt loss 0.16 (as desired); USG 1.040; SDMA: 11
Most recent A&P:
A:
1) Intestines most consistent w/ enteritis (IBD vs SCLSA); ileus likely cause of decreased appetite.
2) Nodes: r/o reactive vs other
3) Cystic strucure: r/o benign mesenteric vs inflamed node
4) Kidneys have evidence of chronic disease ; in keeping w/ previous lab findings.
P:
1) Rx: metoclopramide 5 mg: 1/4 tab po every 8-12 hrs.
2) Continue vit B12 as Rxed.
3) picked up Mirataz but hasn't started it yet. Rec. give. metoclopramide for 2-3 days and then if not improved appt, start Mirataz.
4) to consider presumptive pred tx vs ex-lap for biopsies.
Sammie is seeming to eat better with the metoclopramide.
My question:
Is pusuing an ex-lap for biopsy recommended vs. empiric tx for IBD with steroids vs. empiric tx for SCL with steroids + chlorambucil.
Thank you!!!
Hello,
Well let’s all take a collective moment to applaud the work up!! I say this because that’s a breath of fresh air!! I think that a couple things warrant a little further discussion.
First it sounds like your GP has done a very thorough job,,, but,, done it all in house. Which in some cases is the best we can do. But. Have you been offered a referral to an internal medicine feline practitioner? If you can find someone who is BOTH great. If not go to whoever you can get in with.
Next have rads been done? And assessed by a radiologist? At least for thorax?
I know it might sound crazy but also check anal glands. Some of these older cats are so uncomfortable they stop eating
Add an appetite stimulant. There are numerous options.
Ask for an internal medicine consult via your lab services. It’s a phone call and It’s free. It has been helpful in some cases. Ask them about budesonide vs. prednisolone if you are going to start treating for INS. Which to be honest I would do over a biopsy for a cat this age with these potential differential diagnoses.
I also add vitamin B12 and cobalaquin and immuquin to these guys. The other medication I like is cerenia and learning how to give SQ fluids at home for the kidneys. You also need a phosphate binder ( I think?, please inquire), we use naraquin. Maybe ask about azodyl too.
… and I know it sounds like I am spouting out a lot of meds… but I gave my older cat solensia when she was a nightmare of unhappiness and it really helped.
And let’s not forget pain meds. Every (EVERY!!! ) single patient deserves them. I like gabapentin 50-80 mg as needed.
Please keep m posted. Very best of luck.
Krista.
Dear Krista,
Thank you very much for your response!
Sammie is eating much better since starting metoclopramide. She is finishing all the wet food we give her, and chases after me when I am preparing it for her! She’s also having bigger sized BMs. We also have her on a weekly injection of B12 for her borderline low levels.
One point to clarify – we are lucky that Sammie’s vet is a feline-only practitioner. Based on discussions with her, she seems to recommend proceeding with the ex-lap for the biopsy and that cats “bounce back” quite quickly after the procedure. We are hesitant, however, given it seems quite invasive.
At this point, we are deciding if the is worth it, or just to empirically treat her with steroids for presumed IBS (vs. SCL). Based on your input, it seems you would err on the side of not doing a biopsy in a cat of her age?
Thanks,
Carla
Hello
My name is Parham Parsa, I found your page on youtube and have read your blog, and for once I saw someone that is actually talking about blocked cats and is raising awareness to this issue and I wanted to thank you for it.
My cat Mercury (4.5 years old, 18lbs) is currently in the hospital for another urinary blockage and I genuinely don’t know what to do, this is his third visit, first time he got blocked was about a year and half ago and he was on the death’s door, his blood work was extremely elevated, he was lethargic and in visible pain. His regular vet unblocked him and transferred him to a vet hospital for further care, this visit cost me about $5K, and after that he was put on a strict urinary diet. Second time was 3 months ago where we noticed him being in pain and struggling once again and we took him to an ER vet and he was unblocked again, despite my persistence of leaving the his urinary catheter in, they took everything out, and send him home that very night, thankfully he remained unblocked until last night. His vet told me that since he is keep getting blocked he should just get the PU surgery and all but refuse to see him, so I took him to the Metropolitan vet hospital and their estimate for getting him unblocked and doing the PU surgery was 7-8 thousand dollars which is wildly out of reach for me at the moment. After reading your blog I have decided that if I find a second job I can afford to have him unblocked and kept in the hospital for observation for a night or two but I don’t know what I can do after that. If you have any suggestion regarding an affordable PU surgery or any other suggestion I am all ears. I’m really sorry for the long email, and looking forward to hearing back from you.
I just got off the phone with his vet at Metropolitan and after they took some X-Rays they saw some large stones in his bladder which they suspect could be the reason for his repeated blockages, and recommended a cystotomy and they said that the balance would stay at 7-8 thousand dollars. As of now my plan still remains to have him unblocked and watched for couple of days but I don’t know what I should do next.
PS.. I have attached a couple of pictures of him to this post. He is genuinely the sweetest and the friendliest cat I have ever met and the idea of me having to say goodbye to him just because I can’t pay for his treatment is is something I cannot imagine.
Hello,
I’m so sorry to hear about your cat. So many of these cats have a similar situation and it leaves their families with such a huge dilemma about what to do and how to afford all that might lie ahead.
My advice at this point would also be to do the PU surgery and to remove the stones. If you are close to us I would be happy to see him and see if there is anyway we can help. Please call the clinic and leave your number. I will call you back.
Dr Magnifico
Thank you, Dr Magnifico, I will definitely call the office first thing in the morning. And again I want to thank you for bringing awareness to this problem. Your articles about the blocked cat were such a huge help for me in dealing with this issue.
I have a very special and painful case I need help with, I have tried several different veterinarians with no diagnosis or prognosis so far. It may be a long shot, but I was hoping you could help me shine a light on this.
In April I found an extremely skinny stray cat and took him in. I first thought he was malnourished from lack of food for being in the streets, but 4 months in his case keeps unfolding.
He is likely older than 15 years old, but he’s a happy cat with a lot of energy and mobility. He weighs 3kg but he’s a big cat, you can feel every single bone in his spine, although you can’t see them that easily because he has long hair. He’s completely affectionate, loves to be pet, and asks very politely for attention and food all the time.
All we know about his past is he is neutered, he had some teeth surgically removed and he tested negative for FIV and FeLV.
He had a huge appetite when I first took him in, he would eat 100g of food in one meal and ask for more right after. He would sometimes ‘cough’, it sounded like he was choking on some kind of fluid, it doesn’t happen in sequences, but it happens almost every day until today.
He always drank LOTS of water and produced a lot of urine as well. His feces at the beginning were really solid with some mucus.
After a month, he continued to eat plenty and hadn’t gained any weight, that’s when he started to throw up. It started happening a few days a week, usually after spending several hours without eating he would throw up a clear frothy fluid with no content, and then it progressed to twice every day regardless of when he had eaten.
We suspected it could be diabetes or hyperthyroidism, but the labwork didn’t confirm either, it showed regular kidney function with small liver function alterations.
We then introduced prednisolone (2,5mg/day) and changed his diet from a mix of natural home-cooked protein, hypercaloric wet food, protein supplements, and dry food to exclusively Royal Canin Hypoallergenic while waiting for Royal Canin Gastrointestinal Hydrolyzed Protein to arrive in Brazil, keeping Omega 3 (fish oil) 500mg/a day in his diet.
Vomits went away for a while. He kept drinking lots of water and peeing a lot, but his feces got softer (not liquid).
He had periods where he lost his appetite, which we treated with mirtazapine, he reacted after 6 days.
We performed an ultrasound and discovered that basically all his internal organs were compromised. He has severe alterations everywhere. Still, the best specialists I could find couldn’t tell me what was causing it and offer a course of treatment that didn’t involve opening him up to collect tissues for a biopsy.
I personally think it is absurd that a doctor could look at this frail elderly cat who obviously can’t resist anesthesia without serious risks and say that surgery is the only way to go, all to find out for sure if we’re dealing with a lymphoma or an infection. I’m looking for someone to advise me on the most effective course of action. Of course, I aim to reverse his condition, but I understand that given his age and how advanced it is, it might not be an option.
He is currently at 3kg, eating exclusively Royal Canin Gastrointestinal Hydrolyzed Protein with fish oil, and taking prednisolone every day for a month now. His appetite is healthy, he still drinks a lot, pees a lot, and poops regularly but softer. He eats an average of 5 small meals.
Vomits are back down to a few times a week, usually early in the morning before his first meal, and always a clear liquid. He goes and eats right after throwing up so I get the impression he is not nauseous.
He doesn’t seem to be in pain overall.
He’s not gaining any weight regardless of all my efforts.
That is why I’m giving this a shot and trying to get your attention. I hope you have more resources and knowledge that could help me figure out appropriate next steps to give this little guy the best fighting chances I can.
On this link you’ll find a translation of his bloodwork and ultrasound. I had chat GPT translate it for me so forgive me if there are errors.
Link: https://docs.google.com/document/d/1yqcen-TYzyvfBYU-J4t1tCHola1E2otDGDa1H7V032Y
I appreciate any support you can lend me, his name is Valentim which means brave and strong, and I want him to win this fight.
Hello,
It sounds like you have done a pretty thorough work up. The places I think that you should look into are;
Repeat the blood work. It sounds like hyperthyroidism. I always check a free T4 on top of the thyroid T4. I also check a urine. If you haven’t sent a fecal to the lab too.
After that the ultrasound and X-rays are where I look.
You are still at the place where the diagnosis is eluding you. That’s where you need to focus.
PS. Just for the record I don’t love starting pred until you have a diagnosis. It can obscure your diagnostics.
Good luck. I hope this helps.
My cat is 1 years old Lillyanna is laying around and she is not eating what do I do?
Hello,
If you think that your cat is not acting normally please see a veterinarian. At least have an examination done. Maybe it can be as simple as trying an antibiotic. But please see a vet.
My cat is 1 years old Lillyanna is laying around and she is not eating
@kristamagnifico Please help advise on PU v Cystotomy urgently
Hello
I’m sorry to hear about your cat. The problem is that we don’t know what kind of stones these are and therefore the concern is that more will form and more will obstruct, or , that these are the kind that do not resolve and therefore you will be back here again
If you can afford it I would do a pu and cystotomy to hopefully be done with this forever.
If you are struggling financially ask the vet if they took a post op Xray after the last surgery. If some were left behind (which happens to all of us) ask for a discount on this surgery. At least a discount for the cystotomy portion as the surgeon should have taken a post op Xray and should have gone back in to remove them at this time,,, because of course they were going to cause a re-obstruction.
That’s my advice. Keep me posted. Good luck
Thanks for getting back to me Krista. Can you help me understand why PU alone will not be sufficient? Can the stones be flushed out during or after PU? I will also attach the stone analysis report shortly
The stones are:
90% Calcium Oxalate Monohydrate (Whewellite).
10% Tricalcium phosphate (Whitlockite)
PFA attached stone analysis
My cat has been on medicated diet since Feb 2024 and no new stones have formed since then. Will cystotomy alone won’t be sufficient?