Our Maine Coon Erasmus: The Tale of his Broken Tail

Last updated: Aug.09.2013
Mar.24.2011 to Sept.01.2011 … Apr.25 2014

Erasmus, Aug.04.2013 This is the diary I kept when our boy had a car accident. We think he made a dash across the street in front of a car, and the car trapped his tail for a very short time. Major factors leading us to this conclusion were (a) his claws were very badly damaged as if he had dug right into the tarmac in his terror trying to get free; and (b) his sacrum had gaps where it had been yanked from its pelvic anchor, as well as the tail vertebrae having gaps where it had been stretched. This is a very common form of damage, and the extent of recovery depends on the degree to which the nerve sheaths have been stretched or torn. If only stretched, there is a good chance that torn nerves can grow back. See Chukkie's Sacro-coccygeal Luxation for a very similar accident.
One painful lesson we learned is that Vets don't really know much about recovery patterns in cats with this type of damage, as most cats die long before they have a chance to recover due either to euthanasia or inadequate care. Raz is lucky that we are self-employed, work from home, and so had the time to look after him; most owners are away all day working.
I believe a major factor that contributed to his recovery is his diet – all our boys are raw-fed, and are as healthy as you could wish.
As of August 2013, Erasmus (Raz) is a happy, healthy boy with a slight bend in his tail, and a propensity to get constipation if he eats dry cat food or doesn't get enough exercise. That's all, and it's enough for us.

I don't know what the outcome would have been if I hadn't stumbled over the most helpful and supportive forum HandicappedPet.net. You can read the thread on Erasmus here, and I recommend you do so to get the benefit of all the excellent advice I received.

Quick Links to Resources:
Educating myself via Reading
Educating myself via Pictures
Raw Feeding

Introduction

We have three cats: Heimdall (9 yr-old Heinz 57), Euclid and Erasmus (8 month-old MC brothers). We raw-feed our cats twice a day, and they are trained to come for meals when whistled. We allow them to roam free during daylight hours, as we live in a very quiet suburban area, and they are all micro-chipped. They come in for their supper just before dusk, and are not allowed out afterwards, because I believe that at night cats can no longer see cars, they only see incredibly bright lights which dazzle them and hear a scary loud noise, and they lose their cool. This modus operandi has worked successfully with our cats for over 9 years in different countries.

Week 1: Thu.Mar.24.2011 — Wed.Mar.30.2011

Thursday, March 24
After supper, Erasmus sat in front of the cat flap and bashed it and yelled and was generally a pain in the butt. After more than two hours of this I got fed up, and let him out, much against my better judgment. As the cats get older they are increasingly reluctant to use the litter box, much preferring to go in the garden, and I stupidly assumed that was what he wanted to do. I expected him back after about 20 mins or so ... but he didn't return. We spent hours walking the streets until 2am, whistling and calling, but no Raz.
Friday, March 25
Still no Raz this morning. More walking and whistling throughout the day. When he still didn't appear at suppertime, I started to get really scared. I spent the afternoon registering him as lost, and printed 500 'Lost' leaflets; we spent the evening putting them through letterboxes in the area.
Saturday, March 26
Still no Raz this morning. More walking and whistling. I made another 500 leaflets, and we distributed these over a wider area. Phoned the Council to ask if they had picked up any dead animals. Phoned all the vets in the area to ask if any cats had been brought in. More walking and whistling in the evening.
Sunday, March 27
Raz appeared at 1:30am this morning. He was in the most terrible pain, his tail just 'hung' there, he was dragging his rear end which was canted over to one side, he was crying and growling constantly. He would not stay still, was shifting and moving around all the time. It was clear that something was very, very wrong. My husband got on the phone and tracked down an emergency all-night vet about 20km away, and we drove over there.
Erasmus tail x-ray #1  Erasmus tail x-ray #2  Erasmus tail x-ray #3
The vet took some side-view x-rays immediately. He said that they were inconclusive but it was clear there was tail trauma, and he needed to take a top-view x-ray, but that since Raz was in a great deal of pain, very shocked, and dehydrated, it would be better to give him some pain medication, put him on a drip and a catheter and let him rest, and do the top-view xray on Monday morning, which would require anaesthesia. So we went home, and left him there.
I spent the afternoon registering him as found, and printed some 'Found' leaflets which we pinned to lamp posts in the streets we had previously leafletted. It wasn't a great day. The rest of the time I began to educate myself on cat anatomy, and tail trauma in particular. Here are the articles I found most interesting and helpful.
I also had a good trawl around the web, looking for pictures and x-rays of the insides of cats. Here are the ones I found most useful.
Monday, March 28
Erasmus tail x-ray #4  The vet called and asked us to come in. He showed us the top-view x-ray. Just as in humans, the nerve bundle lies inside the spinal column, and continues through the sacrum, and on into the tail vertebrae (the coccyx, in humans). There are gaps on either side of the sacrum where it has been yanked away from its anchors to the pelvis, and the sacrum itself is sitting 'canted'. This isn't great, and is very painful, but will heal in time. More importantly, the first tail vertebra after the sacrum has a large 'lean' to the left. It is impossible to tell whether any of the nerves at the point of the 'lean' are broken or over-stretched and, if over-stretched, to what extent. The vet said that generally speaking the prognosis was very poor, but that some cats do recover to a greater or lesser extent, and that all we could do now was wait and see. He showed us how to express Raz's bladder, and sent us home with a pile of medication (Meloxicam pain medication, Bethanechol, Diazepam, Lactulose) and very heavy hearts.
While we were there, the vet gave Raz an enema as he was concerned the old poo had been in his system for too long.
We have a large hamster/guinea pig cage which we bought when Euclid broke a bone in his foot and had to be confined for 6 weeks - it is 2 x 1 x 1 metre high, plastic bottom and wire sides+top. We installed it in the living room, made him comfortable, and offered him some food which he vacuumed up.
I had my first go at expressing him this evening, with total failure. I have no idea where his bladder is, how to find it, how to hold it, or how to squeeze. I am so scared of damaging him. It's all incredibly depressing. I spent hours and hours on the web looking for decent pictures of cat anatomy. Here are the best ones I found.
Tuesday, March 29
Raz ate his breakfast with gusto this morning, which is great, because really sick cats won't eat.
Medication: We started him on the Bethanechol (but not the Diazepam) this morning: he is supposed to take quarter of a tablet three times a day. Needless to say, he won't take the quarter tablet - it just ends up wet and smashed and outside of him, I get bitten fingers, and he gets pissed off. The instructions say 'take with water', so I ground it up finely, and tipped it into a syringe (without a needle!), topped it up with warm water, gave it a good shake, and 'injected' the mixture into his mouth. Success!
Unfortunately, the meds are having a bad effect: as soon as he smelled his supper, he started salivating, and then barfed. I gave him water via syringe (although water is available, our cats don't drink it, just spread it around all over the floor and paddle), and waited for things to settle down. They haven't, he's just getting very skinny.
I spent most of today web-surfing, learning about the meds we are stuffing him with.
Wednesday, March 30
Medication: We have refined the syringe-pill-taking: Raz gets onto his stool in the kitchen and gets two pieces of kibble; he then happily lets me syringe the pill/water mixture into his mouth; then he gets two more pieces while I refill the syringe half-full with water to make sure (a) he gets all the medication and (b) to ensure he gets some extra water; he then drinks that; and finally gets two more pieces.
It is very alarming how much the cats love kibble - it makes me think of the poem "Heroin in Whiskas" by Martin Newell. ItsyWe have kibble in the house because our oldest cat Heimdall eats it - we have tried absolutely everything, but he flatly refuses to eat raw - unless it's a mouse he has caught for himself. We used to have a MC boy the same age as Heimdall, but he died in June 2010 of kidney cancer. That was my wake-up call to never, ever feed kibble. I miss my Itsy so much, he really was the most wonderful companion, incredibly smart, superb hunter, ..., just the most perfect cat one could ever wish for. If I had only known that I was slowly killing him by feeding him that rubbish.
Urine: We are using baby nappies cut in half to express Raz onto. I cut the elastic bits off, and lay it across his leg, as he gets very agitated if any pee goes onto his fur. It is a real pain, because every time he wiggles, I have to stop and reposition the damn thing. There must be a better way!
Food: We started assisted feeding this evening with a syringe, he doesn't love it but puts up with it. He still barfs, and not much goes down.

Week 2: Thu.Mar.31.2011 — Wed.Apr.06.2011

Thursday, March 31
Medication: I spoke to our vet and we took him off the Bethanechol today. I pray this is the cause of him not wanting to eat. Normally Raz is a real pig.
Pee problem: Raz seems to know when he needs a pee, and gets very agitated (it doesn't leak at all). He insists on repeatedly squatting in his litter box, despite the pelvic pain. I've read so much about expressing, studied every pic and x-ray I can find on google images, been back to the vet several times for lessons (he's a lousy teacher), and still can't do it. Raz will not lie on his side, he will only lie on his tummy, and even then my husband has to scruff him. His tummy muscles get very tense, and finding the bladder seems impossible. I did find it once and got two great squirts going, but not since - I don't think he has a bladder any more. He's now very cross about the whole thing, and as soon as I put my hand on his tummy he growls, hooks my hand really hard (ouch!) gets up and walks off. Because of the pelvic damage I can't use one hand around his spine, I've been trying to express him using only one hand. If his hip area is even touched, he cries. Things are getting worse, not better.
Questions:
  • can I damage or hurt Raz in my rubbish attempts to express him? I've read that urine can get forced back up to the kidney!
  • does his bladder really need to be completely emptied, or is it good enough to just get some out?
  • how will I know if he has an UTI?
  • how much time do I have to learn in, before UTI becomes a real danger?
  • is it usual for cats with this damage to know that they need to pee? The vet was amazed, and said it was a very good sign.
Stool: Our cats normally poo every couple of days, and the stool is small, firm, fairly dry and very low-odour. Nothing whatsoever has arrived since he came home. We haven't used the Lactulose yet.
Questions:
  • should I assume that because the nerves controlling his bladder sphincter are damaged, the poo-controlling ones are too?
  • will peristalsis still move the stool along the intestine?
  • although he's not eating much, should the stool still arrive?
  • how can I tell if he's constipated? I've tried to feel his tummy, but can't feel anything much.
  • should I just use the Lactulose, or wait to see if I need to?
  • what about using ground flax seeds instead of Lactulose?
  • given that he doesn't really drink water, would using Lactulose cause dehydration?
Friday, April 01
Medication: Raz is no longer on any meds as of today. We took him back to the Vet, and he said he thought the meds were making him too sick to eat, so we should try without for a few days.
Urine: I got a real "hands-on" expressing lesson. This time the Vet was great (I think he finally understood how frantic and anxious I was feeling), took his time, and I think I've finally got it. I've also been stroking, tickling and massaging Raz's tummy in between expressing him, to try and get him to relax and think of it as fun. This is definitely paying off, I can now get him to lie on his side, cock one leg in the air and let me get on with it - no more scratching, hissing or growling. Yay!!
Because I'm worried that I'm not expressing Raz either enough or sufficiently frequently, I did some research on bladder size, urine quantities and colour, etc. so I have some idea about what to expect:
  • Bladder shape and size: when full, a normal cat's bladder should be about the size and shape of a lemon. Larger than this means the bladder is being over-stretched, with this result.
  • Urine amount: this depends on how much the cat is drinking. Normal cat urine production over a 24 hour period is between 20-44 ml/kg. Each time the cat pees can vary in quantity, but the 24 hour period should be within the indicated range.
  • Urine color: it should be clear, and yellow or amber.
    If the urine is cloudy and red it indicates that there is blood in the urine.
    Yellow-brown, greenish or yellow, dark brown, foam: may indicate some type of liver problem
  • Urine odor: A weak ammonia odor is normal. Smell such as a strong ammonia-like odor might indicate a bacterial infection (sepsis). An odor that smells like a paint solvent (acetone odor) or sweet smell may indicate diabetes mellitus, acetonemia.
We've bought half-a-dozen identical terry towelling facecloths, which all weigh pretty much the same. After Raz has been expressed, we weigh the wet facecloth, subtract its dry weight and bingo - we know how many ml we've managed to get out of him. Hopefully, as I get better at it, I will be able to tell from the feel of the bladder how full he is at the start and how empty he is at the end. But right now it's all very hit-and-miss with lots of praying.
Poo: This isn't looking good. The vet showed me where/how to feel the stool in his intestine, and it's clear there's loads in there, but it ain't appearing. He gave Raz something called Microklist Rektallösung (trans: Microklist rectal lotion). The website (http://www.microklist.de/) says it contains: 450 mg sodium, Dodecyl (Sulfoacetate), 45 mg sodium, sorbitol solution 70% (crystallising) 4465 mg, other ingredients: glycerol, sorbic acid, purified water. Usage: for short-term use in applications for diseases and constipation, which requires assisted defecation. God knows what all that lot do, because I don't! The vet said we should see something within 24 hours, otherwise call him.
Saturday, April 02
Food: Raz sauntered into the kitchen, asked to be put on his stool (our cats each have a stool they sit on while I get their food ready), and sat and yowled "Where's my food!!!" He's been eating steadily since, which is an enormous relief, he's already looking less gaunt. He's clearly in much less pain, and is walking a lot more easily.
Stool: So far (15 hrs later) nothing's happened. I am feeling rather confused about this. Peristalsis moves the stool along the bowel. It then requires some effort on the part of the animal/human to push it out; but if this effort doesn't take place then surely the stool will eventually appear on its own? From trawling the web I understand that Raz's bladder and anal sphincters are closed, and the nerves controlling the opening phase are damaged; is this the exception, and incontinence the rule?
In my web research I keep seeing the phrases "Diminished Anal Tone" and "Zero Anal Tone". Could someone please explain what they mean? Also, many articles/posts talk about urinary/foecal incontinence, which I understand to mean "leakage". But Raz has the opposite!
Monday, April 04
Stool: I had a good "poke around" this morning to see what's what. You can now really feel the stool in his large intestine, right up to about 1cm short of his anus. I tried to put my fingers (ever so gently) alongside the stool-nearest-the-exit, but Raz got really upset (hissed, spat, bit). The initial x-ray showed a broken (and crushed?) vertebrae, and I'm starting to think that this lies just above his anus. His anal sphincter is definitely closed shut; I tried the 'greased thermometer trick' and it took some fiddling around to get it in (it had no effect, by the way). Guessing here: might he be holding the sphincter shut because it hurts?
I just tried touching his anus again to see if it flinches, and it doesn't seem to, but its very hard to tell because he gets really antsy when I try.
Medication: Back to the Vet's again this afternoon. I asked the Vet about Cisaparide, and he said he didn't like to use it unless absolutely necessary; he wanted to give things a few more days. He also put some lotion (don't know what) in Raz's bottom to try to get things moving.
Urine: I watched the YouTube videos recommended by HandicappedPet.net with great interest, but couldn't help flinching a bit - boy, those guys are really rough with the cats! But it was incredibly useful to see the massaging and bowel evacuation actually being done. I think I'm going to try a very gentle massage and see where I get with it - surely that's got to be better (less unpleasant for the cat) than an enema?
Tuesday, April 05
Acupuncture: Raz had his first session today. I'm incredibly lucky in that (a) I have a professional acupuncturist for a sister-in-law, and (b) she lives in the next street over! She loves Raz very much, and offered to come 3 times a week for a month or so. How fantastic is she?
Stool: The Vet just called to ask if the lotion yesterday afternoon had worked (unfortunately not). We then talked about massage, and he told me to give it a go, but to bring Raz in tomorrow morning if no joy. So I'm going to try that right now. Question: is it possible to rupture or tear the intestine doing this? The people in the videos seemed to be quite firm (almost rough), so I'm guessing one would have to be quite clumsy to hurt the cat?
Medication: We started him on Lactulose today (1 ml twice a day).
Wednesday, April 06
Tail: Back to Vet #2 this morning. He looked very gloomy, and told us that Raz's tail would have to be amputated, because (a) the weight of it is causing him pain, (b) the weight is counterproductive for healing, (c) he has no control over it and cannot keep it out of harm's way ie. being stepped on, caught in doors, etc., (d) Raz is constantly tripping over it and sitting on it, and (e) it's very difficult to keep it clean. I was absolutely determined that amputation would be a last resort, and when we got home I trimmed all the fur off his tail to make it lighter and easier to keep clean.
Stool: They didn't want to give him an enema because he would have to be sedated and they felt he'd been sedated far too much over the last 12 days. The vet mixed up some mineral oil and water, and put it into his bottom to soak the stool and lubricate matters; he also said that he had broken the stool up into pieces. About 5 mins later a large lump came out, the vet looked pleased, and said more would come when we got home, if not then bring him back Fri.am.
I've been wondering if it would be safe for me to try to give Raz a warm-water enema at home. I've never done this (nor had it done to me). What's involved? Does one have to be trained to do it?
Unfortunately, nothing's happened this evening; all we have is a lumpy-looking bottom, with a closed sphincter. Raz let me massage his tummy for ages this evening, but we don't seem to be able to get anything out, despite vaseline, gloved fingers, etc. I do feel hesitant about squeezing as I'm afraid of something getting damaged. It all seems so hopeless (glum, gloom).
Acupuncture: He had another acupuncture session this afternoon.
Sore Skin: We have a very serious problem: Raz is continually licking his rude bits, and it's got to the point where there's no fur left, the skin is red and raw, and there are a few places where he's actually licked the top layer of skin off. I bathe him with warm water and cotton wool to keep him clean (which he loves having done) but he still insists on licking himself. I have been putting my hand over the area to stop him, which pleases him not at all. A last resort is an E-collar, but I am very reluctant to use that, poor guy is so fed up as it is, that would be the last straw, I think.

Week 3: Thu.Apr.07.2011 — Wed.Apr.13.2011

Friday, April 08
Urine: I tried pillow+litterbox technique this morning, and it worked like a charm, (except that at the end I get lots of drips and she doesn't). My husband cuddles+strokes Raz while I make a mountain of work trying to express him. It's much less hassle than putting newborn-size nappies under him.
Back to Vet #1 again to see if he says anything different from our normal vet (who is great, but there's nothing like a 2nd opinion).
Stool: Raz is still getting very stressed out because he can't pass any stools. I can feel a very hard lump just before his anal sphincter. I greased up a glove, and hoiked it out for him - he wasn't impressed, but clearly feels relieved.
The vet did another xray to see what the stool situation was. Turns out only the large intestine was full, the rest of the system was pretty empty (one of the blessings of raw feeding, I guess). He said he didn't think anaesthesia+enema was warranted, and showed me a large roundish 'plug' a few inches back from my poor guy's bottom. He said he thought things would move along if that was removed. So the vet and I donned latex gloves and he gave me a lesson. Turned out the 'plug' was a large chunk of hard stool, matted hair etc. effectively damming the works. He/I pulled out all we could reach. Raz was definitely not impressed, but started looking relieved immediately afterwards. It's really scary putting one's finger up there and curling it around to scoop things out, I'm amazed the colon will expand to that extent!
I am now armed with a bottle of mineral oil and a squeezy-bulb thingy; this is only for lubricating things near the exit, and not for enemas. The vet explained about enemas, and I must admit I'm not confident about stuffing that much tubing up inside Raz without damaging something. He also said that doing this to a cat in pain is a truly bad idea, and that it would be best done under anaesthetic. I told him about CarolC's "lobster claw" massage, and he said that sounded like a wonderful thing to do.
Acupuncture: he had another session this afternoon.
Sore Skin: He reckons that Raz is constantly licking that area because it's the closest he can get to the source-of-his pain. He gave me some stuff to put on the skin, and said I would have to E-collar Raz for a few days to allow it to work. Poor guy!
Urine: The vet said he didn't think Raz has a UTI, but he took a urine sample to test anyway. Oh yes, and he gave me points for the state of his bladder (nearly empty), yay! But he said my "techinique" needed improvement, and showed me a different way.
Medication: The vet also said that he thought we should re-start the Bethanechol, as it encourages the nerves to heal by stimulating the muscarinic receptors; it apparently also encourages intestinal motility and peristalsis. But we should stop it if it makes him sick again.
Nerve Damage: I got the vet to talk me through the view-from-the-top xray again, as I didn't really understand what he said on the night we originally took Raz in because (a) I hadn't educated myself on feline anatomy at that point, and (b) he speaks very fast, and my medical German is sadly lacking, and (c) I wasn't in a great state of mind at the time.
So it turns out that the sacrum has a gap on either side where it should be 'glued' to the pelvic bone. He said this isn't a huge issue, and is something that time will definitely heal.
More importantly, the first tail vertebra directly below the sacrum has a huge lean to one side; this is where the nerves are either torn or stretched, and only time will tell. The vet said that ideally he would like to see a small improvement each week, and promptly gave Raz a battery of tests.
  • He now has fully functioning reflexes in both legs.
  • He has regained tail feeling in the first 3cm and the last 3 cm, but nothing in between (?? how can that be ??), but he can't move it at all. The vet made the point that even if he could move it he probably wouldn't, because that first tail vertebra (the leaning-over one) is the point of flexion, and it would hurt dreadfully.
  • He is now walking straight (his pelvis leaned horribly over to one side in the beginning).
  • The vet thinks peristalsis is working just fine.
  • Finally (excitement, excitement) I swear to God that I saw Raz's anus contract a couple of times when he tried to poo. But the vet said it might have been automatic, and not to get too optimistic. But I can't help myself!!
Saturday, April 09
The weather is absolutely gorgeous, hot, sunny, lazing around type of thing. So I've been taking Raz out in the garden for supervised walks a few times a day - not the most interesting thing to do for a human ☺ He got seriously cross when it was time to come back inside, growling and hissing and generally making it known that he wanted to be outside. He wouldn't eat, wouldn't drink, fought me at pee-expressing time, etc. etc. Despite an evening of petting and stroking, nary a purr was to be heard, indeed no kind of acknowledgement of my existence whatsoever. When I put him in his cage for the night, I plonked down 150 grams of food and left him to it. This morning I smiled to myself when I saw the plate was empty.
Sunday, April 10
Today is again beautiful, and Raz is constantly hassling to be out again (sigh). He's in a much better mood, thank goodness. While we were sauntering around the garden, sniffing plants and rubbing his facial glands along branches etc., he turned around, presented his rump to the bush, sortof-lifted his tail and cocked it to one side, and sprayed - I could actually hear the spray as well as see it, it wasn't one of your half-hearted sprays. I couldn't believe my eyes, so I rushed in and got my husband (who didn't believe me either), and we went round the garden again, all together. Yup, he did it again, it really happened. Which I hope means that Raz is getting back some sort of control of his urinating muscles. Back to the internet for more research on cat spray. Here is what I discovered.
Raz's brother Euclid didn't come home for supper tonight. We walked round the neighbourhood at 8pm, and again at 11pm, whistling and calling, but he's nowhere to be found. Oh God, I can't bear it if he has had an accident too. We didn't sleep at all well.
Monday, April 11
A very glum start to the day, with still no Euclid. We were aimlessly pottering (instead of working), when the little so-and-so turned up in the garden. He sauntered around, pausing every now and then to yowl "Wo ist meine Frau?" He then came in and demanded to be fed, and ate like a horse. Absolutely nothing wrong with him, and very full of himself. However, Raz keeps 'jumping' Euclid and biting him (very hard) on the scruff. Can he have forgotten his brother in 24 hours?
We took Raz for a walk around the garden this afternoon, and he did his spraying thing again, but this time no urine came. I guess this is one of those "two steps forward, one step back" things.
Acupuncture: Raz had another session this afternoon, and again sat very quietly.
We had a visit from another cat this evening. Our cats sat inside the house peering through the cat door, while the other cat sat on the other side. All three were wailing, yowling and growling. It's clearly time for these two to get castrated.
We have decided to get a quote for fencing our entire garden.
Tuesday, April 12
We took Euclid to be castrated this afternoon, and Raz came along too so the vet could take a quick look at him. The vet said he thought we should wait a bit longer before neutering Raz because of the stress from the anaesthesia, but while we were there he gave Raz a couple more tests - and he said he could see a tiny bit of anal tone (he tapped the anal sphincter and it responded ever so slightly). Euclid was dreadfully woozy when he came home, and just wanted lots of cuddles all evening.
Urine: I had a dreadful time expressing Raz at suppertime, the pee just wouldn't come, and I got scared of damaging him by squeezing too hard. What's wrong? It's been going so well! Could the Bethanocol be making it more difficult? I eventually had to give up, I'll try again later on this evening.
I finally managed to express Raz at 11pm, it was still difficult but we got there. I took a rest half-way through, and watched in disbelief as his penis came out by itself and a small amount of urine arced through the air. These tiny things give one hope.
Wednesday, April 13
Euclid is clearly feeling much better after his op. yesterday, and is hassling to go outside (sigh).
Urine: Amazingly, Raz was super-easy to express this morning, it was almost as if he was helping me. I am still failing to completely empty his bladder, though - I get it about three-quarters empty, then it becomes incredibly difficult to hold and feel, and Raz gets squirmy and fed up. I really hope he doesn't get an UTI, and this amount of emptying is good enough.
Stool: He needs a poo, and is constantly in and out of the litter box trying to go, but without success. He is constantly licking his butt, and it's getting very sore. If he doesn't succeed, I will have to hoik the poo out again.
I took him for another walk around the garden after lunch, hoping the exercise will help his peristalsis along and get the poo moving. He had another acupuncture session this afternoon, and when the third needle was placed he relaxed completely - and a poo popped out!
After supper, we had another walk in the garden. When we came back in he was clearly cross, and kept licking his bottom - yup, another poo on the way. He wouldn't let me help him with it, but snarled and growled and lashed out, and when he moved to scratch me, his anal sphincter contracted and another poo came out. Does this mean that the nerves are slowly hooking back up? I tried tapping his anal sphincter to see if there was any reaction, and there did seem to be, but it's really hard to tell.

Week 4: Thu.Apr.14.2011 — Wed.Apr.20.2011

Thursday, April 14
Urine: Raz was impossible to express this morning, he wouldn't relax, wasn't interested in treats or cuddles, just kept on growling and snarling. Got about half of it out, then had to give up and let him go. We have to find a better solution than nappies to express him onto.
We took both boys out into the garden this afternoon. Euclid ran around like a mad thing, clearly overjoyed to be out of the incredibly boring house. They both spent ages trying to catch a mouse behind the compost bin (but failed). Then of course we had to patrol the perimeter, and do the spraying thing ... when Euclid saw I was taking Raz back inside he shot up the plum tree, no way was he going back in, thank you very much.
Stool: The poo problem is getting me down, and clearly stressing poor Raz out too. He goes in the litterbox less and less, it must be incredibly demoralising to keep trying but nothing happens. Nevertheless, he gave it yet another go, then came out looking cheesed off. I picked him up to give him a cuddle - and a poo fell out onto the floor. WTF?? Suddenly his anal sphincter opened?
All three cats 'helped' me make cat food (lamb) this evening. At pee time, Raz was clearly very tired, and this made him relax, which in turn made expressing him very easy. I wonder why he's so tired all of a sudden?
Friday, April 15
Urine: This morning Raz was actually impossible to express. He growled and snarled and kept wriggling and trying to run away. Also, I had to squeeze his bladder scarily hard and even then only got about 2 tsps out, and then had to give up. A most unpleasant experience for all. I will try again in a couple of hours when he's calmed down a bit. Nothing wrong with his appetite, though.
Lunchtime: still no success with expressing, same story as this morning. What is going on? I took him out for a nice saunter round the garden, which he really enjoyed. Having a fairly full bladder doesn't seem to be bothering him. He's lifting his tail even higher now in his attempts to spray plants. Another couple of poos dropped on the floor today, just after unsuccessful visits to the litterbox. Oh god, I hope he's not losing his house-training.
Afternoon: I still can't express Raz, he actually howls (in pain?) when I try. Perhaps he's got a UTI? We've made an appointment at the vet's for this evening. In the meantime, he's only too happy to 'help' with the two-monthly cat-food-making ☺
Evening: the vet had enormous difficulty in expressing Raz to get a urine sample to test for a UTI, but finally managed to get a teaspoon out. The test came back borderline: maybe yes, maybe no. She said we should play it safe, and started him on antibiotics (I don't approve - over-use of antibiotics is, in my opinion, extremely stupid). She also gave him an injection of a muscle relaxant which targets the bladder muscles, but also has an overall effect, so that I can express him at home this evening. She said one often sees this problem when feeling is starting to come back (wahoo!). Raz scarfed his supper, and is now out cold. It was indeed much easier to express him this evening. I read up about the nerves controlling bladder function.
Saturday, April 16
Another beautiful day. Raz spent most of the day in the garden with me, walking around and investigating interesting smells and noises and sunbathing. He enjoys it very much, but I find it incredibly tedious as I can't afford to take my eye off him for more then two seconds. He's getting more and more bolshey every day, making his displeasure at being 'messed with' ever more apparent (and painful for me).
Urine: expressing him today was again unpleasant, with him constantly yowling, wriggling and struggling to get away. I tried a different tack this evening: my husband fed him tiny bits of treats one at a time, and the little rascal just lay there and let me express him with no trouble at all - he was only interested in the next tidbit. Whatever it takes is good for me. At least it's now clear I'm not hurting him, otherwise he would have yelped instead of scoffing. Still no sign of him being able to pee or poo by himself, though.
Medication: He hates the Lactulose which I usually syringe into his mouth, so tonight I tried putting it in his food - which he then refused to eat, so I had to make him a fresh, unadulterated dish (sigh). I don't think it actually makes his stools softer. I think we are going to stop using it for a couple of days and see how we go.
Tail: Another milestone: I was giving him a tummy and tail massage just before bedtime, and there's no question - he can move the end of his tail. Also, the tail itself showed some resistance, instead of being a limp, lifeless thing.
Sunday, April 17
Tail: Again. gorgeous weather; again walks in the garden. There's no question: Raz's tail is no longer dragging on the ground, he holds it clear!
Urine: I think we've found an amicable solution to expressing: the dish of treats sits on the table while we express him on the couch, and he is prepared to let me do it - but the millisecond we are done "Good boy! All done!" he leaps towards the treats and scoffs them. This is a solution I can live with, here's hoping it continues so.
The vet said (on Friday) that I should express Raz three times a day, but I am finding this impossible to do. I've been expressing him ca. 10am and ca. 11pm; and there just isn't very much in there at suppertime! I usually fail to completely empty Raz's bladder as he gets extremely impatient when it comes to the last 25%, and this worries me as I've read that bacteria can breed in stale urine. He still isn't showing any signs of peeing.
Stool: He seems unaware when a poo comes out. He has completely stopped going into the litterbox to try to poo - I think he's just completely demoralized.
Monday, April 18
Urine: Expressing continues to be less than satisfactory - I just can't get the damn thing empty. We are going to have to settle for 80%, I guess.
Stool: On the off-chance, I tapped Raz's sphincter this morning, and there's no question - it contracted visibly and undeniably.
Questions:
  • Everyone says "express 3 times a day". Raz rarely drinks water, he gets it from his raw food diet. Is the "3 x daily" schedule for kibble-fed cats? I've searched the net for clues on how often raw-fed cats pee, but unfortunately found nothing.
  • If he can hold his tail off the ground (ca. 3 inches), does this mean anything in terms of pee and/or poo capability in the future? Do some incontinent cats nevertheless have use of their tails?
  • What exactly does the anal sphincter contracting really mean in terms of continence? There's the 'push' element of voiding, and the 'pinch' element. Is it possible that he will be able to 'pinch' but not 'push'?
  • Will expressing his bladder stop him from trying to pee by himself, because there's no bladder-generated signal to do so?
  • Is there a danger he will became un-litterbox-trained? Expressing and massaging take place on the couch. Should I try to express him over a small litter-box so he does not disassociate?
Tuesday, April 19
Urine: It's getting very hard to express Raz. I feel like I had the knack and now I don't.
Medication: I wonder if the Bethanochol is making my life difficult? I think I will take him off for a couple of days and see what happens. He had two quarter tabs today, but not the third this evening. He is still off the Lactulose, it will be interesting to see if his stools are harder or not.
Tail: I was testing his tail this evening to see if the middle part 'belonged' to him yet, when I noticed that the long hairs at the end of his tail were definitely moving when I gently squeezed the middle part of tail.
He's running a lot now in the garden, chasing his brother around and ambushing him. He is carrying his tail even higher off the ground, although he still has to hold it up and over to one side rather than straight out behind him. Raz can really run! Euclid caught a mouse (poor thing) and brought it onto the patio to play with it. He was having a great time, and Raz was watching him jealously. Euclid's attention was distracted by some birds arguing for a few seconds - and his mouse was heading down the path, firmly gripped by you-know-who.
On our walk around the garden this morning, when I saw him trying to spray I patted his rude bits with a paper towel - and sure enough, there really are a couple of drops of pee. Here's hoping ...
Stool: I tried putting Raz in the litterbox when I saw him licking his butt, which is the signal a poo is on its way, but he was less than impressed, just fought to get out. He stomped back to his cat TV (smack in front of the see-through cat flap in the back door), growling and hissing. A few minutes later I heard him 'covering' something, and sure enough the poo was on the floor. I have a horrible feeling he is becoming un-trained. Tried again later, with the self-same result (sigh).
Acupuncture: He had another acupuncture session this afternoon.
Raz can climb (a bit)! The cats were chasing each other in the garden, and one shot up the plum tree, and before he quite knew what he was doing, Raz was following, although he only got about 12 inches off the ground.
Wednesday, April 20
Urine: It was very, very hard to express him this morning, even harder this evening. What am I doing wrong? I'm so scared I'm going to damage him. I didn't give him any Bethanocol today either, but so far life isn't getting any easier. We have moved onto using towels with an old plastic bag underneath for expressing him onto, but that generates a huge amount of laundry.
Stool: He definitely had difficulty getting stool out today, and really doesn't want me to help. I think they are actually harder than they were a couple of days ago, so I've started him back on the Lactulose at suppertime this evening. I tried again to persuade him to use the litterbox, but he didn't want to know. This evening he was sitting on the couch with his blanky and making bread like crazy on it with all four feet, and I noticed a poo starting to come. I think it was as a result of his hind legs working away. Surely this means he will get control back at some point, as it's clear the muscles are acutally working, although he doesn't have control of them yet.
Tail: Another milestone: I was messing with his rear end checking for poos coming, and he was growling and snarling, and the end of his tail was definitely switching back and forth!
Also, he actually managed to jump from the floor onto the highest stool in the kitchen this evening: he stood on the floor and made his "please pick me up and put me on it" noise, but I was doing something else and told him to wait; at which point he eyed the problem, shifted back and forth a bit as if he were going to try to climb up, but then jumped. Yay!

Week 5: Thu.Apr.21.2011 — Wed.Apr.27.2011

Thursday, April 21
Urine: We went for the garden patrol this morning before expressing; I wanted to see if Raz was more successful at spraying with a fuller bladder - and he is! Only a couple of drops come out each time, but by the time he'd checked all the spray-spots his rear end was unmistakably damp.
However, expressing him this morning was incredibly difficult. We have an appt. with the Vet at 5pm this afternoon to discuss matters.
We had a lovely afternoon in the garden, all three cats just lazed around, in between times checking out likely holes in the ground.
The Vet also had incredible difficulty expressing Raz (which made me feel less inept). I talked to him about the difficulty I have in expressing Raz three times a day, and he said that was an ideal, cats are individuals, and it was clear that twice a day was working just fine. The amount he had got out was about two teaspoons which he said really wasn't worth worrying about. He did say that he thought giving him extra water wasn't a bad idea, although of course it means more work getting it back out again.
Tail: He said he was very surprised (and pleased) that his tail is alive and working, and that it was an excellent sign.
Stool: He also said that there was an awful lot of stool in his colon, and I should massage it out asap. He said it's still difficult to tell what the final outcome will be, but things are definitely looking good.
Medication: And he also told me to put him back on the Bethanocol asap.
Back at home, I settled down on the couch, draped with a towel, toilet paper and latex gloves to hand, and started massaging Raz. This is normally something he loves, but he got cross almost immediately, and jumped down and stomped off back to his cat TV (see-through cat flap). I sat there for a few minutes looking at the wall, then to my surprise I heard scraping noises coming from the litterbox. Yes, he was in there, squatting and pushing, and produced a poo all by himself! Oh, happy, happy day.
On a not-so-glad note: Euclid disappeared off this evening, ran across the road and disappeared. I am sitting on eggs waiting for him to come home. He eventually turned up at 1am, looking very pleased with himself, and jumped onto my lap for an intensive cuddle (which he got).
Pretty much failed to express Raz this evening; got about a teaspoon out after much effort, at which point Raz got really stroppy and refused point blank to cooperate, so we gave up. Hopefully tomorrow morning will bring success.
Friday, April 22
A gorgeous day again, rather hot and muggy though. My brother James arrived mid-morning, and we all sat around in the garden chatting, while the cats futzed. My son Cerion, Ine (his wife), Anwen and Arlo (their small kids) arrived just before lunch, and we all had lunch together in the garden with my brother Stu and his wife MC (the acupuncturist). Raz spent most of his time sleeping under the Juniper. Anwen can't help shrieking with excitement, which scares the cats, so I kept Raz in the bedroom quite a lot. He left us a present of a poo on the duvet ☹
Urine: It's still really difficult to express him, plus he is getting ever more unco-operative. I have got to find a solution to this.
Saturday, April 23
Urine: I tried a different way of holding Raz today, which definitely seems to make life easier. Rather than lying him on his side with his head facing away from me, I reversed it so that his head is pointing towards me. And unbelievably, it was incredibly easy to express him. I don't know if it's due to the different position, or his bladder is relaxing somewhat. I used the same position this evening, and it was again easy to express him, but he did struggle somewhat. It's very puzzling: if he gets treats during the expressing process he absolutely ignores what I'm doing, but if he doesn't, then it's just one big fight (sigh). The down side is that his tummy muscles become very tight when he's munching and/or looking for the next treat.
Tail: His back is definitely straighter, and he is running across the garden without hesitation now. His tail no longer forms a 'loop' when he sits down; he can switch it when he's cross, and arrange it tidily.
Stool: But still no sign of him being able to pass stools easily or pee by himself.
Sunday, April 24
Urine: Raz is definitely easier to express using the new position, but the down side is that he is daily becoming less co-operative, and struggles to get away pretty much non-stop. It is very wearing, and I worry that I am hurting him - but then he lets me get on with it if he gets treats. I wish I could be sure that he isn't in pain when I express him.
No changes today that I can remark on.
Monday, April 25
Raz managed to escape into the neighbour's garden while I was saying goodbye to Ceri & Co, but he did come when called.
Again, no changes today that I can remark on.
Tuesday, April 26
Urine: Today I noticed that when I was massaging Raz's tummy (which I always do before expressing him to get him to relax) a few drops of urine appeared on his penis. Does this mean anything? I have no idea.
I had a lot of trouble with him today, the new position does seem to make expressing his bladder easier, but he is struggling all the time which makes life difficult. I don't like it when I can't get visual feedback that I am pressing his bladder in the right way+place, but eventually I had to give up trying to do it with him lying on his side, and allow him to lie on his tummy. It is very trying.
Stool: Still no sign of him doing poos or peeing by himself.
Wednesday, April 27
Urine: Expressing Raz today was a real trial: he did not want to co-operate at all. Eventually Julian had to hold him down by force both times. However, it is much easier to actually get the pee out, it doesn't seem to require any real strength at all.
Stool: He isn't passing stools as easily as I could wish - he does try in the litterbox from time to time, but gives up very quickly, and just waits for them to fall out. I don't know if it's my imagination, but his back seems to be more hunched than it has been for the last week. However, he's in good spirits, and is eating well.
Jumping seems to be becoming easier for him too - this evening he jumped from the windowsill onto the top of the fridge, albeit somewhat awkwardly. I worry that he's pushing himself a bit far with this.
Acupuncture: The session this afternoon did not go well at all - he seemed cross and anxious, and did not relax - after about 10 mins he jumped out of his basket and hid his head under my arm, then jumped down and ran away, biting at the needles as he went. Very odd, he has always responded very well and been very relaxed.
Stool: Just before bedtime tonight, I was sitting on the couch with Raz giving him a tummy massage, and he started making bread like fury - and pushed a poo half-way out. I had to help him get it the rest of the way out, as it was very hard.
Questions / Comments
We are now at the end of Week 5. I read on the MarvistaVet page "most cats who do not recover urinary control after a month probably will remain incontinent" and "Tail function and sensation tends to take longer". Well, Raz definitely has both tail function and sensation, but no urinary control; he also has quite good anal tone now. I guess this just goes to prove that we are all different!
But on a more serious note: if Raz is going to recover bladder control, is there some sort of timescale that I can look to? My husband is very supportive, but is nevertheless adamant that a permanently incontinent cat has no place in our lives. He says he's prepared to do absolutely everything and anything that's necessary to help him recover, but not long-term. So I'm extremely concerned! It doesn't help that Raz is so uncooperative - expressing him usually takes at least 30-40 mins, and leaves everyone feeling upset, with pee everywhere. Is it likely that he's still in pain? Although he's jumping a bit, it's not much really. He is still very careful, and chooses to climb rather than jump when he can. For some reason, I sortof think that when he can jump properly again, he will probably pee and poo. Does this idea have any medical foundation?

Week 6: Thu.Apr.28.2011 — Wed.May.04.2011

Thursday, April 28
No changes today that I can remark upon.
Friday, April 29
No changes today that I can remark upon.
Urine: Raz is still really hard to express, and seems to dislike the process more and more.
Medication: We have stopped giving him Bethanochol as of today lunchtime, to see if it makes any difference.
Saturday, April 30
Urine: Raz was still difficult to express this morning. I had to get Aldous to help me because Julian was away for the day dancing. I think I only got him half empty.
Stool: He desperately needs to pass a stool, but won't let me help him.
Medication: Starting this morning, we have upped his Lactulose from 1.5ml twice a day to 1.5ml three times per day.
Tail: He is definitely carrying his tail higher, and even starting to switch it when he's excited or annoyed.
Sunday, May 01
Raz bounced around all day in the garden and had a good time - he even caught a mouse all by himself, and ate it loudly with every evidence of enjoyment.
Urine: Expressing him was just as difficult as ever; stopping the Bethanochol doesn't seem to have made any difference.
Medication: However, upping the Lactulose has definitely helped him to pass stools more easily.
Stool: Raz has completely stopped going in the litter box and trying to poo, he just waits for it to come out. It's weird - sometimes when we are sitting on the sofa he starts making bread with all four feet, and really pushes to get a stool out, so it's clear he can do it, so why isn't he doing it all/more of the time?.
Monday, May 02
Medication: We got the prescription for Diazepam filled this morning, and started Raz on a 1/4 tablet twice a day. The Vet said "Give 1/4 or 1/2 tablet twice daily". I forgot to ask Julian to specify Valium (see Valium - Uses). We will put him back on the Bethanochol tomorrow morning.
Urine: Raz definitely seems a little stoned, but was nevertheless difficult to express this morning. This evening he was more laid back, was prepared to lie down and lift his leg, he even purred a bit - but overcoming the bladder's resistance was just as hard as ever. I don't know if it is my imagination, but his bladder feels somehow flabbier - I wonder if this is a result of him not taking the Bethanochol?
Raz had a good time in the garden this afternoon - he even played football with Euclid and Heimdall. Acupuncture: We have decided to stop the acupuncture for the moment, so no session today.
Tuesday, May 03
Medication/Urine: The Diazepam seems to knock Raz out - he spends a lot more time snoozing. It doesn't seem to have the desired relaxing effect, though - he's just as hard to express as ever.
We put him back on the Bethanochol today. I think it definitely gives his bladder more tone - it's much easier to find and hold.
Stool: It's clear that he's not voiding stools often enough - the poo sits just before the tightly-shut sphincter and dries out into a hard lump, which then hurts him to get rid of. It gets so dry that a small part of his anal tract comes out along with the poo. This is not good, I'm going to have to help him get rid of it more often, even though he hates me messing with his bottom.
Wednesday, May 04
Urine:Something has changed wrt expressing Raz, I don't know whether it's the Diazepam or whether I've finally discovered the exact location to press, but the pee comes out so easily! He still struggles and squirms, which makes life difficult, but now I am expending strength to keep a hold of him, rather than squeezing him. Thank God, because I absolutely hated pressing so hard on his poor bladder.
Stool: I've been "popping" lumps of poo out of him as often as possible. I can feel when there's something "in the queue", and it's really easy to pop it out. It does seem to be important to do this as often as possible so that it doesn't get a chance to dry out. But he does hate it so!
We went to the Vet today for a "control" visit. The vet gave him a thorough check-up and said (a) he didn't have much stool in him and (b) his bladder was in great shape, no thickening or anything (phew). But he then pulled a long face and said he didn't think the prognosis was good, and that Raz wouldn't make much more progress. Annoyingly, Raz refused to demonstrate his "tail prowess" and just let it hang like a piece of rope (grr).
The vet also said that it wasn't recommended to keep on with the Bethanocol and the Diazepam for much longer than one more week.
I tried to put him on the spot re an expected final outcome, and was amazed when he shrugged and said "I don't know". What?!?! It turns out that he has no experience with this kind of injury past the 5 week point. He said that most owners whose cats have this kind of injury just cannot cope, and that the cats were either euthanised, died of a ruptured bladder, or got a horrible bladder-thickening problem due to bad expressing technique and had to be euthanised. I was flabbergasted to hear all this and just stood there with my mouth open spluttering "But what ... but why ..." He said he hadn't mentioned it before because if one doesn't tell people what they are trying to do is difficult, then they succeed more often. I guess that's a fair point.
Anyway, we have agreed that we will take Raz to the 3-month point and then re-evaluate the situation.

Week 7: Thu.May.05.2011 — Wed.May.11.2011

Thursday, May 05
I think I've found a solution for what to use to express him onto. I bought half-a-dozen terry facecloths and a very cheap bathmat, which I cut in half. I lay the bathmat on the bed, the facecloth on the bathmat, and the cat on the facecloth. Voila! They are very easy to rinse out, and dry quite quickly; I put them in the washing-machine when they start to smell too strong.
Monday, May 09
Medication: We stopped the Bethanochol and Diazepam today. I guess it will take a few days for them to completely leave his system. I am really interested to see how he is without any chemicals in his system. I am still giving him Lactulose, and I still think it isn't terribly effective. Does anyone have any dietary suggestions on how to make his stools softer? I do give him lots of extra water during the day, but I think it's all ending up in his bladder ☹
Urine: We got really fed up with the twice-daily struggle and decided to try and analyze what was going on. We always start with a purring pussycat and end up with a snarling one, so clearly there was something going on. It turned out that what Raz had been objecting to all this time was getting pee on himself!. So now we drape a towel with a piece of thin plastic underneath over his left leg, so not even one drop of pee touches His Majesty's fur, and all is well - no more struggles, no more arguments. How I wish we had discovered this sooner! All this time the arguments on his side were completely reasonable. We have been the stupid ones.
On a different note: when it gets near to expressing time, he often sits with his lipstick out and licks it. I can't help thinking he knows he needs to go, but can't get it out.
Stool: He has managed to go a couple of times in the litterbox. He clearly knows when he needs to go, but mostly just gets fidgety and licks his butt. I usually end up "popping" the stool out for him, which he hates.
The chief problem is that his anal sphincter is shut tight, and he cannot open it at will. This means that the stool sits near the exit for quite a while, drying out. When it becomes hard, it hurts him when it is forced out by pressure from within. I've seen that part of his anal tract sometimes comes out with the stool, it looks sortof stuck to it. So I often pop his stool for him when I feel it, in order to save him grief later.

Week 8: Thu.May.12.2011 — Wed.May.18.2011

Thursday, May 12
We are now at the end of Week 7, and I think all the meds have left his system. What I think is now clear is that his bladder sphincter and anal sphincter are pretty much clamped shut.
Stool: When I pop a stool for him, it is very difficult to get it out, and it clearly hurts him.
Urine: When I express him, even though I massage him quite a bit at the start, I have to squeeze quite hard to get things started. Since stopping the Bethanochol it usually comes out in a sortof fast dribble. But when we get about half-way through, it often starts to come really quickly and easily. I don't understand that at all. Does phenoxybenzamine relax the anal sphincter as well as the bladder? I feel sure Raz would happily poo by himself if only he could open his sphincter.
Friday, May 13
Things are now changing very slowly, not much is different from one day to the next, it is only when one looks back that one can see the differences. Life is definitely easier these days. We have a schedule now, and all three of us (Raz, my husband and me) know what to expect and when. Life seems positively simple now when I compare it with a month or so back.
Urine: Hard work expressing Raz this morning - it all came out in a slow dribble. I was sweating by the time we were done.
Stool: I popped a stool for him this morning, and saw a smear of blood on it. Did I make this happen by squeezing too hard to get the last stool out?
Evening: Raz really needs a poo, but gets really upset if I try to pop it for him (sigh). I waited till he was licking his butt a lot, then gave him 1.5ml Lactulose. This seemed to do the trick - when we went upstairs to express him I put the small litterbox in the room, and he went in it and after two or three tries managed to get a decent-sized stool out. The stool was still quite hard, but there seemed to be quite a lot of liquid stool around it, enabling it to slip out. Raz definitely pushed the stool out, I could see his rear end contracting and pushing it out.
He was really hard to express again, although when he stretched out it became easier. The bladder definitely feels "flabby", not firm and round like it used to when he was on the Bethanochol.
Comments:
Raz is definitely regaining tail use, but the jury is still out as to the final percentage. He still mostly holds it with a funny left turn at the very top, but I think even that is slowly disappearing. He holds his tail out from his body now, and sometimes it is even horizontal, though not for long. He even curls it up tidily beside himself when he sits down.
He is climbing trees quite happily, and has no problem making the initial leap onto the trunk, then climbing right to the very top. We can't help worrying and standing under the tree 'just in case', but he is very agile; it is clear he is using his tail for balance. However, he still has issues jumping down - he used to take a flying leap off the trunk from about 4 ft. up, but now he carefully climbs 90% of the way down. His aversion to jumping down is illustrated in the house too - he will choose to eg. hop from the sofa to a stool, then carefully hop off the stool to the floor. We assume that this is pain-related in some way.
He is running like fury, chasing around with the other two cats. It is noticeable that he doesn't swerve and dodge with the same ease that they do, but neither does he keep in a straight line like he did a couple of weeks ago. Now he is happy to turn, crouch and spring-ambush, which usually results in a rolling over-and-over pile of fur. I can't tell you how great it is to watch. In fact, I'm sitting here typing with a foolish grin on my face remembering earlier on this evening in the garden ☺
Saturday, May 14
Acupuncture: MC came over for another acupuncture session today, which didn't go at all well. So we have decided to stop them completely for the time being.
Sunday, May 15
Urine: I am getting worried about the increasing difficulty in expressing Raz, this "fast dribble" just doesn't seem right. But apart from that, he's so happy!
The bladder feels kindof flabby; I cannot get a urine stream, the urine just dribbles slowly out. It takes ages to get him empty. At the end, I don't feel like the bladder is empty, but it is hard to tell. Raz is clearly fed up with the whole process taking so long, and twists and struggles a lot.
From my reading:
  • a weak detrusor muscle (situated in bladder wall) = inability of the bladder to contract.
  • internal sphincter muscle: a circular muscle located at juncture of bladder and urethra; it is a continuation of the detrusor muscle, under involuntary control; primary inhibition/release muscle
  • external sphincter muscle: secondary sphincter, located slightly further along the length of the urethra.
Excellent article on Neurogenic Bladder here.
Tail / Food: But he is eating well, and his tail continues to slowly improve.
Monday, May 16
We took Raz to Vet #1 this evening for a checkup (he hasn't seen him for about a month) and to talk to him about the weird "fast dribble", Miralax and Phenoxybenzamine. He was extremely pleased with Raz's progress, and said that he really expected that Raz would eventually pee by himself. He gave him a physical check-up and said that Raz's bladder felt completely normal and had good tone.
There wasn't enough urine in Raz's bladder for him to express to get an idea of the "fast dribble" problem, but he asked us to bring in a urine sample for analysis. He also said that phenoxybenzamine would have pretty much the same effect as bethanochol, so he didn't see the point in using it, and anyway Raz shouldn't be put back on these meds. I was somewhat puzzled as this info contradicted what Critters at HandicappedPet.net had said.
I asked the vet about Miralax, and he said that since Raz is almost pooping by himself (I haven't helped him at all for the last 3 days) I shouldn't bother changing but rather slowly cut down on the Lactulose over the next fortnight. Nevertheless, I think I will keep on with it for another week first, just to make sure Raz is voiding ok.
Tuesday, May 17
The "fast dribble" problem continues. I took the urine sample into the vet's at lunchtime. He phoned later on and apologised for giving me incorrect info. re the phenoxybenzamine and said that in fact he thought it was a good idea, and would write a prescription for me.
He also said that he had found struvite crystals in the urine sample and that we should immediately put Raz on Hills Prescription Diet Feline S/D. I went to the Hills website to read the ingredients list and was appalled. Raz and his brother have been 100% raw-fed since they walked through our door at 4 months of age.
Assuming that there are indeed struvite crystals present, is it possible that they formed because his urine is staying in his bladder too long, as I only express twice per 24 hours, and perhaps his pH is fine? Or does a high pH always go hand-in-hand with struvite crystals? Or perhaps I am not giving him enough extra water, so his urine is too concentrated?

Week 9: Thu.May.19.2011 — Wed.May.25.2011

Thursday, May 19
I spent a great deal of time this week researching the thorny problem of "urine pH and struvite crystals". Unfortunately, I have ended up rather confused. Here is some of the info I found, and below is a summary of my questions and comments. Obviously I want to do the best thing for Raz (despite my "religious convictions" about raw feeding), and I am terrified of him "blocking". What to do?
Summary:
  • "Prescription diets work by removing magnesium to prevent crystals from forming" - but magnesium is essential for health.
  • "Prescription diets mostly contain grains" - but grains cause alkaline urine.
  • "Hills Prescription Diet Feline S/D takes 6-10 months to remove an existing problem" - no way do I want my boy on that rubbish for that amount of time. And the Hills website says this diet is not suitable for any period of time.
  • "A small amount of crystals is not an abnormal finding in cat urine and the cat should not be automatically put on a prescription diet" - surely a vet would know about this?
  • "Genetics plays a huge role in urinary health" - so what can one do?
  • "Hard tap water has high magnesium levels so use distilled water" - but this has most minerals removed. Would bottled spring water be better? Or rain water?
  • "Hypovase relaxes the muscle in the penis so allows the crystals to easily pass" - should I ask the vet to prescribe this rather than Hills?
  • "Once outside the bladder, a free-catch urine sample can form crystals in 30 mins ... also the pH may not be accurate" - the sample was given to the vet ca. 2+ hrs later, so maybe Raz doesn't have crystals at all? Surely the vet would know about this?
  • "Prodoca Guardacid pills acidulate the urine and regulate the pH value" - perhaps we should think about using these?
  • "Urine pH becomes more alkaline after eating a large meal" - we feed twice daily, should this be 3 or 4 times instead?
  • "Bladders are happier with more water flowing through them" - I add a good dollop of water to his meals, and he has fresh water available at all times. He gets 1.5ml of Lactulose am and pm, plus ca. 3ml of extra water each time to compensate.

Week 10: Thu.May.26.2011 — Wed.Jun.01.2011

Friday, May 27
After everyone's supportive comments and helpful suggestions last week on the HandicappedPets Forum, we decided that Raz did not have struvite crystals, and just soldiered on.
Medication: We got the phenoxybenzamine prescription from the vet (Dibenzyran), and I was horrified to see that he recommended ¾ of a 5mg capsule twice per day - that seemed like an awful lot - I read on the web that the max. recommended daily dose for a cat is 2.5mg!! So I started him on ¼ of a 5mg capsule twice daily, and waited to see what happened, which was a big fat nothing.
Urine: So every few days I've been slowly increasing the dose, and in the meantime Raz has been getting increasingly harder to express. I don't know why exactly, but I really get the idea he is fighting me with his muscles at pee-time. It's scary how hard one has to squeeze to get things started, so I boned up on where the bladder sphincter is and I've been trying to massage it at the start rather than just "lean" on the bladder. I don't know if it helps or not, but it makes *me* feel better. The other odd thing is at the half-way mark - we take a break to (a) allow my arms/hands a rest and (b) to allow his bladder to reform. It is definitely much easier to express him after the break, and we sometimes get a real stream, instead of the awful slow dribble.
Office Cat TreeHe finally got up to the ¾ twice daily dose yesterday, and I really hoped that today would be different - but it wasn't. It's taking us about 45 mins to express him, and it's really hard work the whole way. His pee has slowed down to practically a drop-by-drop exercise, and our hearts are very heavy. This evening was really trying, and I had to give up before we were done as he was clearly extremely unhappy. I've been sitting at my desk working (it's 3am here) trying not to think about it all, and all three cats are asleep on their cat tree. I heard Raz licking himself, so I went over to give him a cuddle - and found him sitting in a puddle of pee on his cushion!!!! I have no real idea how it happened, or why, but I was never so glad to see a mess in my life - my guess is that he was asleep, and the bladder relaxed - is this possible? I cleaned up the pee (while he was trying to bury it), and wiped him down, and gave him a few treats and a cuddle. He happily curled up and is now sleeping. Please god, let this be some kind of breakthrough.
Tail: I think I can definitely say Raz has 95% tail function. I deduct 5% because he still has a tendency to hold it somewhat kinked to one side, and when he really runs down the garden it still "flaps" slightly. But apart from that, he holds it out well and truly high behind himself, wraps it round himself when sittiing/lying, sticks it high in the air when he rubs himself on my legs, etc., etc.
Stool: On the poo front: I haven't helped him at all for ages. I was checking his butt all the time up till the middle of last week (which he didn't appreciate one bit) but I was worried about impaction. Since then, the space between his pelvis and his anus is always empty, yay!! And I've been watching him poo, it's clearly still difficult, but he gets there without help, does all the correct "pinching" stuff with his rear end, etc. A couple of times he hasn't been 100% successful with the pinching and when he turns around to inspect the results they aren't there! He does look surprised and digs furiously to find the stools, it's so funny to watch. So I pluck it off him and put it in the litterbox in front of him and then he's delighted and buries it.
The mouse-breeding season is now well under way - the silly things are living and breeding behind the compost bins, and we call it the "Maus Laden" (mouse food-shop). We let the cats out about 7am for a run while we make coffee etc., and most mornings he brings back a mouse for his breakfast. It's a really nice sight to see him walking down the garden with the current catch firmly grasped in his mouth. Our friends say he is unrecognisable from the sorry cat of a few (very long) weeks ago.
If anyone had told me a couple of months ago that I would be yattering on about pee and poo in such gory details I would have told them to go boil their heads - but just listen to me drivelling on! Sorry guys, I can't help being happy about the puddle of pee, and it's perhaps making me a little light-headed ☺
Question: Is it possible for a cat to regain both tail function and poo function, but still have a locked-up bladder? I've been surfing like fury trying to find out, but without success. I can't help hoping and praying.
Sunday, May 29
Urine: Raz has been getting steadily more difficult to express over the last couple of weeks, despite first Diazepam, and then Phenoxybenzamine. The moment I had been watching slowly draw closer finally arrived last night, when I entirely failed to get one drop of wee out of him. After 90 mins we gave up, and decided to try again this morning.
Well, this morning was just the same - as dry as the proverbial desert. So we made an appt at the emergency vet and off we went this evening at 6pm. After every test under the sun, including ultra-sound and x-rays, the results are: he has great kidneys, a normal size, very healthy-looking, no stones etc.. He has a great spleen, ditto. He has a great bladder, no crystals, stones, plugs or anything else (except a lot of urine). And so on. The vet absolutely failed to get a single drop of wee out of him as well, and finally took a urine sample for analysis via a hypodermic through the bladder wall. The results (can you guess?) were 100% great: super Ph, no blood or anything else that doesn't belong there, etc., etc. The blood test came out ditto, 100% super. He's a very, very healthy cat - who can't pee!
The vet said we should leave him there overnight so he can be catheterised, plus she wanted to see if the catheter went in easily, or if there was some kind of blockage. She said that she has seen cats who hold their sphincters shut tight, but she didn't know why this should be so. She did suggest that perhaps he still had some pain, or that the nerves were sending signals which he found uncomfortable/painful. Who knows. Anyway, we left him there with heavy hearts, because actually, we have no choice now. We shall see what tomorrow brings - she said she would phone us in the morning to let us know what happened re the catheter going in easily or not.
Monday, May 30
The Vet called back this morning: he found absolutely no obstructions in the urethra. They observed him trying to urinate this morning, without success. He said that his guess was the detrusor muscle was clamped shut, and that the urethra also had high resistance. He also said that he thinks the nerves are trying to regenerate (and possibly sending painful signals), and that the puddle I saw on Saturday was very symptomatic of this, and this could also be why expressing him causes him pain. The depressing part is that there is no way of telling how long it could take for the nerves to regenerate, or indeed to what extent they would regenerate. Because he is now "locked up tight" the only way to get the urine out of him is via catheter, and he says this isn't something I could do at home. Is this true? Has anyone done this themselves at home?
I did some websurfing to find out about catheterisation.
The Vet told me that there are no surgical procedures available for the problem, and the only thing we could try was medication. He said he was going to keep him for another 24 hrs and give him Myocholine (Bethanochol) together with Diazepam, to see if this would help. But he said he has seen this kind of problem many times before and the outcome is usually euthanasia.
I can't bear it, I really can't. After all this time, effort, money, etc, to fail at this point is just unthinkable. Especially when he is so healthy and happy in every other way. Is it really not possible to catheterise him at home for a few weeks to give these damn nerves a chance to regenerate? Surely there must be some other solution? Somebody help please! I refuse to give in - his quality of life is so great, except for this one £$%^&* show-stopper. Arghghgh!
Tuesday, May 31
The Vet called this morning. It turns out that I misheard him on the phone yesterday - he said that he put Raz on Bethanochol/Myocholine and Phenoxybenzamine/Dibenzyram (*not* Diazepam) at the following doses:
Date Drug Name Drug Qty Daily Frq. Dose Total Daily Dose
May.30 Bethanochol / Myocholine 10mg tablet 3 x ¼ tablet = 2.5mg (10.5mg wt) 7.5mg (31.5mg wt)
May.30 Phenoxybenzamine / Dibenzyram 5mg capsule 2 x ¾ capsule = 3.75mg (12mg wt) 7.5mg (24mg wt)
He said these were very high doses, and not a great idea, but ok for the short term in this case. Anyway: he was very, very happy - he said that Raz peed all by himself this morning, and that 3 other people witnessed it (he called them in because he got so excited!). He wanted to keep an eye on him for a few more hours to see if the peeing was a one-off, and we agreed that Raz would be better off at home (less stress) so we could come and pick him up this evening.
So off we went later on to bring Raz home again - I'm sure I don't need to tell you how happy we were, as opposed to the journey taking him in on Sunday! The vet said that Raz clearly knows when he needs to pee, ie. he knows when his bladder is full, which was a good sign that the nerves governing this were in good shape. But he also said that it is possible that the pudendal nerves were damaged and that the urethra will never relax (without drugs) during detrusor contraction - and all we can do is wait and see.
I asked him about using Prazosin and Dantrolene (which CarolC had told me about). He did know about them, and had heard good things, but he said "Forget it, no-one can afford this in Germany." It turns out that the cost is ca. Euro 30 per tablet (arrghgh).
We brought Raz home, and he was clearly very happy to be here; he immediately had a dust-up with his brother, just to make it clear who was still boss. Poor guy, we hovered over him like brooding hens, watching to see if he would pee! Time passed, and he wolfed his supper, but no pee. More time passed, and then I noticed that he was leaking pee - but he still didn't go near the litter-box. We decided to leave him alone for the night and see how things went. For a relaxing evening (hah), I boned up (again) on Neurogenic Bladder and scanned through Problem-based Feline Medicine, Chapter 12 "The Incontinent Cat".
Wednesday, June 01
Raz was still pretty full this morning, although he had clearly got rid of some pee during the night. I am not comfortable with leaving him full all the time, in case of nerve damage, so decided to express him. Joy and delight: it was soooo easy in comparison with these last weeks of struggle. He lay back and purred, and purred, and let me get on with it.
Generally speaking, a very good day, he clearly hadn't eaten much in hospital, so made up for it every chance he got. He did go in the litterbox a couple of times, but only tiny amounts came out (sigh). We expressed him again this evening; again, not at all difficult.

Week 11: Thu.Jun.02.2011 — Wed.Jun.08.2011

Thursday, June 02
Not much change from yesterday, although at expressing time he insisted in going in the litterbox beforehand and afterwards. I thought I had emptied him, but he clearly didn't agree, and promptly finished the job himself. Not nearly so much leaking today.
Friday, June 03
I sat down to express Raz this morning - and found to my surprise that his bladder was almost empty - but when I let him out for his run earlier this morning it had been fairly full. So clearly something is working, although I've no idea whether he is still doing lots of small pees, or decent-sized ones.
I've noticed that when he is sleeping, he drips - but not when he's awake. Could this mean that the bladder sphincter is under some kind of conscious control??
Saturday, June 04
Raz's bladder was again almost empty this morning, although he clearly needed a poo. I let him out for his run and sure enough he returned shortly afterwards all nice and empty and begging for his breakfast. It's very hot now (June) and the cats find it enervating: Euclid ran across the garden this afternoon and collapsed with his mouth open when he got inside.
Disappointment this evening: Raz's bladder was fuller than I was prepared to leave, so we expressed him. What a nightmare! I think that was the single worst expressing experience since the beginning. He growled, and squirmed, and clawed, and generally made our lives as difficult as possible. I wish I knew what was going on - was he just fed up after not being expressed for a day, or is the phenoxybenzame not working well and he has pain?
Sunday, June 05
Raz was full again this morning, so it looks like his self-peeing is currently not happening (sigh). We decided to take a "quality-time" approach to expressing him, as neither of us want to live through another experience like last night. So it goes like this:
  • we all go into the "peeing room" together; Raz gets to run around while we put towels out and get stuff ready; he also gets some biscuits.
  • tummy massage from me + cuddles and strokes from Julian. I keep this up till the first drop of pee appears, which can take between 5 to 10 mins.
  • Then we let him run around in the hope that he will go into the litter-box and attempt a pee, but usually he just tries to steal biscuits.
  • Back onto the bed, two more biscuits, then we get to work with more massage; the pee comes in a few mins. A sortof "milking" squeeze seems to work well for him rather than a full-on squeeze; he wibbles his rude bits when he feels the pee coming.
  • About 70% of the way through, we take a break and let him run around the room again. This is partly to give my hands a rest, partly to see if he will pee himself, and partly to let his bladder reform.
  • More biscuits to coax him back onto the bed, and get the rest of his pee out, with more cuddles and chats. Getting him really empty is hard work and he does get a bit impatient.
This approach has worked consistently three times now, with no growling or squeals, so I can only conclude that he isn't in pain. However, it does consume about 40+ mins, which is rather tedious. But it seems to work!
Monday, June 06
We did the "quality-time" thing again this morning, and again had 100% success. Thank God.
The vet phoned this afternoon for an update. He said that he had consulted with various colleagues over the weekend to see if anyone else had come across a similar situation, but without success. He was very disappointed to hear that Raz had completely stopped peeing by himself, and confessed himself dumbfounded. He said that we should continue as we are for another two weeks, and keep the medication at its current (high) level. He agreed this wasn't great, but said he was clear out of other ideas.
The "quality-time" approach worked again this evening.
For light reading, I read Inability to Urinate.
Tuesday, June 07
Again this morning the "quality-time" thing worked well.
BUT not this evening - I gave up after 30 mins, having acquired approx. 2ml in total; Raz was starting to get restive. Fortunately he didn't have much in him to start with, say about 10ml. But he was leaking a tiny bit all evening ... go figure.
Wednesday, June 08
Well, old Raz certainly was very full this morning, but after 45 mins of "quality-time" we finally got him empty. It was astonishingly difficult to get the first few drops to come, I had to squeeze pretty hard.
It poured all day, and all three cats sat on the back doorstop watching the high-velocity drops hit the step - they were patting the drops and playing with them, it was so funny.
This evening's expressing was a complete nightmare, after 30 mins of really leaning on him without even a single, tiny drop, we had a coffee-break. Again I had noticed earlier in the evening that he was leaking a tiny bit. The more I think about it, the more I disagree with the Vet, I don't think he has bladder muscle contraction issues, I think either (a) the bladder neck is stuck shut or (b) his urethra won't relax. Anyway, we finally got him fairly empty after nearly an hour, but I had to really squeeze. And rather scarily, he would sortof 'jump' from time to time and eep - I'm really worried that I'm forcing urine back up into his kidneys, and this is causing him pain. He struggled and fought quite a bit too. It doesn't seem to me that the drugs are having any effect at all anymore, we are pretty much back at the same point we were at 10 days ago on Sunday, May 29th. Where the hell do we go from here?
I did a lot of research on tube cystostomy and re-read Coco's Mom's posts at HandicappedPet.net about his 'button'. I tried to PM her to ask how he got on with it, but unfortunately she hasn't been around since Dec.2009 and the message is still sitting in my outbox. Anyone got any ideas? Anyone know any vets anywhere in the world who might know more about this problem than my two vets here?

Week 12: Thu.Jun.09.2011 — Wed.Jun.15.2011

Thursday, June 09
I was up all last night reading about Urine Retention and didn't get to bed till 6am (I really must get a life one of these days), so poor Raz didn't get expressed till 13:30 (guilt, guilt). I sat down to express him with a heavy heart, fully expecting failure - but it actually went pretty well, and we were all done under 30 mins.
It's clear when he starts to help: he sortof lengthens himself, and straightens his back, and then the pee comes in a proper 'stream' (albeit a small one) rather than dribs and drabs. I wish I knew why he decides to help at some points but not at others. He got very annoyed towards the end, I think I make a bit of a painful mess out of getting him properly empty.
However, the evening expressing was truly bad: after 45 mins the towel was still as dry as a bone, Raz was very fed up indeed, and so were Julian and I. In desperation, Julian held all four paws tight and I squeezed Raz really hard, and finally got about half out, at which point we gave up.
Not a good day - I kept feeling like I was about to burst into tears all day.
Friday, June 10
Expressing Raz this morning was definitely an all-time low to date. He was very full because I hadn't emptied him last night. Every single time I got a drop of pee to drip out, the little shit would squirm and wriggle and growl, and I would lose his bladder and have to reposition my hands. I do not believe he was in pain, but I am mystified why he should object so much. After 90 minutes of him cursing and swearing and generally making life as difficult as possible, I had only managed to get him ¾ empty, but neither Julian nor I could stand any more crap from him, so we called it a day - at which point Raz leapt off the bed and into the litterbox, squatted and did a tiny pee all by himself.
We went outside into the garden for coffee and to discuss where we go from here. Julian said that he had had enough and couldn't go on like this any more. I must confess I too am getting pretty fed up and desperate. We decided to leave things as they are until Monday morning, and then talk to the vet about a possible Cystostomy, preferably one with a cap.
To cheer myself up I decided to spend the day gardening and ignore the mammoth amount of work on my desk. The weather was warmish, and all three cats came outside and helped sow grass seed. I saw Raz twice (!!) squat and do a pee - WFT is going on?? He caught himself a mid-afternoon mouse-snack, climbed the neighbour's scarily high tree, and generally had a good time
Surprise, surprise - at the evening expressing he was almost empty. He lay down and purred and purred, and I got about 8ml out of him with no trouble at all - we were all done in 15 mins flat, which is a bit more like it! Pray God this marks a turning of some sort.
Saturday, June 11
Something is definitely changing, although we shall see whether it is temporary or permanent. Again this morning in the garden I saw Raz squat and do a decent-sized pee, and at morning expressing time Raz was again almost empty: I got about 10ml out of him.
Same thing in the evening: again, less than 10 ml.
It is very odd: when we sit down for expressing and I start to massage Raz's tummy, his bladder is pretty firm and easy to find. But after 5 mins of tummy massage he relaxes, and his bladder goes all floppy, which does make expressing him a lot more difficult. I would have thought that the Bethanochol would force his bladder to be in a firm state. I don't understand.
Raz spent the evening asleep on the small sofa, and dribbled pee - I haven't seen him dribbling for a couple of weeks, so why now?
Sunday, June 12
It's unbelievable - Raz was again almost empty both this morning and this evening. But the very best part is that it took less than 10 mins to express the remainder. Yahoo!!
Monday, June 13
This morning was again a breeze - Raz only had about 10ml in his bladder, and we were all done in 7 mins flat.
This evening it was hard to get him going. He had about 20ml in his bladder, and I think I got about half of it out, but he wasn't happy and wriggled and growled quite a bit, so we gave up after 30 mins. We shall see what the situation is in the morning. He dozed on the sofa beside me all evening, and again dribbled a bit.
Tuesday, June 14
I saw Raz trying to pee early this morning, but without success. I presume his being extra-full due to not being emptied properly last night was motivating him to try. Expressing him took about 20 mins, and wasn't too bad.
At the evening expressing he wasn't nearly as full as I had expected, which makes me hope that he is doing some amount of peeing by himself. However, he did have a lump of poo just before his anal sphincter, which I haven't seen for some time, so I popped it out for him (he wasn't impressed). But what's interesting about this is that we haven't thought about his pooing for ages, but clearly he is not 100% back to normal.
Wednesay, June 15
A really yucky present beside my pillow this morning - a small poo! Raz must have come into the bed at some point last night, and he usually crawls under the duvet and makes bread like fury - which of course gets his tummy muscles going, with this icky result. I guess we are taking a backwards step at the moment (in the style of "two steps forward, one step back".
It took quite a while this morning to get Raz going - about 20 mins, but after the first drop appeared the rest came fairly easily, and we were all done in 30 mins. I definitely got the feeling that he was helping, but I can't explain how or why.
This evening: Raz was very full, which I suppose means he didn't pee at all by himself today. But it went pretty well: it took 10 mins to get the first couple of drops of urine out, and then it came thick and fast. I still find it very difficult to get the last 5% out, which is when he gets fed up. About 30 mins all told.

Week 13: Thu.Jun.16.2011 — Wed.Jun.22.2011

Thursday, June 16
Expressing Raz this morning was another nightmare - 90 mins of pressing really hard, the pee would only come out drop by drop, he wouldn't stop wriggling and arguing - arrghghghg! And yet, and yet - we went outside for coffee and croissants and the little beggar dug a hole in my newly seeded grass and did a decent-sized pee. Go figure.
Raz's issues seem to have resolved into a single one of peeing. I have read so much literature it is coming out of my ears. I found an absolutely brilliant description of the urinary system in Fundamentals of physiology: a human perspective. I think that his problem is getting the internal urethral sphincter to open - but I'm still reading about the urethral sphincters, so we'll see.
We are going to have to do something about the castration problem. Raz is getting seriously stroppy, and is beating the other two cats up all the time, which is making them miserable.
The Vet phoned this evening to see how things were going, and was both disappointed and puzzled by my report of "Sometimes he pees and sometimes he doesn't." He says that just doesn't add up in a physiological sense. I offered up the idea that the healing nerves could be 'short-circuiting', so's to speak. He responded with a thoughtful "I wonder if there could be some tiny particle that sometimes goes into the urethra and partially blocks it, and other times doesn't.". I also told him that Raz was becoming impossiblly stroppy, and beating up the other cats all the time. So, in short, Raz is to go in tomorrow morning to have his goolies chopped off, and at the same time he will be catheterized and back-washed, to ensure there are *no* particles or anything else in his urinary system.
The evening expressing wasn't too bed, only 30 mins (feels like a holiday after this morning). It still takes 10+ mins to get the first drop of pee out, but I didn't have to squeeze really hard, thank goodness. It is puzzling why the pee only comes in a sortof fast dribble, though. Either his urethral sphincter is only partially opening, or there is something partially blocking the urethra (sigh).
Friday, June 17
We took Raz to the Vet this morning to be castrated, poor guy. The Vet called for a chat this afternoon: he said the castration went well, but he wanted to talk about the peeing problem. He said that they had catheterized him and drained his bladder completely, did an x-ray to check how his sacrum was healing + an ultrasound on his bladder + washed out the bladder + urinalysis + every test under the sun (you should have seen the size of his bill!). But he said they were alarmed to find complete bladder atony, ie. the bladder did not contract at all after being emptied. He said this was really, truly bad, and understood that expressing him was difficult and time-consuming, but that I really needed to be a lot more aggressive and keep him as empty as possible in an effort to reverse the problem. He said we should therefore continue with the bethanochol+phenoxybenzamine for the moment.
The trouble is, it's a bit of a circular problem. I have noticed that it has been getting harder and harder to empty Raz, the last 10+ml or so is almost impossible to get out, and the problem has been getting slowly worse. But I need to get everything out if we are to reverse this problem - how to manage this?
I am now raddled with guilt that in fact I have created the whole pee-problem or at least made it worse than it was. As I read more, I understand more about how the urinary system works. Good bladder tone is crucial for the correct operation of the internal urethral sphincter; is it possible that by only expressing him twice daily I have in fact been contributing to making matters worse, because the bladder spent too much time being full? Dear God, please no.
The Vet and I also talked again about Dantrolene. He said he only knew it as a people medication. I offered to email him various articles + the info CarolC sent me, he will look into it and we will talk again soon. The $64,000 question is whether it is Raz's external or internal urethral sphincter that's being the problem - or possibly both! The Vet said there's no way of telling short of surgery and then afterwards finding out that the wrong one got cut ☹
We went to pick Raz up this evening, he was really glad to see us. But he can't talk properly, he is all croaky, and I can hear a weird sortof rattling sound when he breathes; but the worst thing is he's being really, really hyper. He won't settle down, he just paces and jumps up, then down, then walk around ... endlessly. He wolfed 40 grams when he first came home, then another 40 grams an hour ago, and he's making it clear that more food is a Really Good Idea. I am feeling extremely trepidant at the idea of trying to express him while he is in this state (gloom, gloom).
We really tried to express Raz this evening, but he was so incredibly hyper that it just wasn't worth the hassle; I will have to start my new 3-times-per-day regime (8am/4pm/12pm) tomorrow.
Saturday, June 18
Poor Raz still can't talk properly today - his usual loud chirp is a sortof muffled squawk. Added to which, he has horrible diarrhoea, which I understand can be an after-effect of anaesthesia. His castration wound is healing nicely though, no sign of any redness - although we are having to wash his butt quite a bit due to the diarrhoea, which he's being very stoic about having done.
I tried to express him by myself this morning, and after 20 mins of frustration, gave it up as a bad job. Later on Julian and I did it together, and I was somewhat alarmed to find that Raz is clearly finding the process very painful. I have read that catheterization can result in painful peeing for a couple of days, but he had no issues at all last time, so I am somewhat surprised this time round. I don't suppose a new Vet. Assistant did the anaesthetic tube and the catheter ... if so, I'm not pleased. Let them go practise on someone else's 100% healthy cat (grr).
Anyway, I tried to pay special attention to getting him as empty as I possibly could, which unfortunately took rather a long time. It's weird, but his bladder is seriously 'floppy' since he came home - there's really no tone at all, and expressing him is very difficult.
He isn't his normal self at all - spent all day and night pretty much asleep. And he hasn't tried to pee by himself at all.
Sunday, June 19
Raz seems a little better today, thank goodness the diarrhoea seems to have disappeared. He is eating like a horse, but still sleeping a lot, which I guess is no bad thing. Expressing him is a whole new ball game with this weird floppy bladder which I can't get hold of. I did some web-surfing to see what I could find out, and it turns out that the anaesthetic that the Vet used was Isofluran, which has a negative effect on acetylcholine levels, the chief neurotransmitters used by the parasympathetic nervous system (see Isoflurane Modulation of Neuronal Nicotinic Acetylcholine Receptors ...). And low acetylcholine can mean urinary retention (arrghghghgh!) because:
Acetylcholine acts on the cholinergic/muscarinic receptors found on the surface of muscle cells in the bladder wall; this causes the muscle in the bladder wall to contract, and thereby the bladder to empty. Low levels of acetylcholine mean the bladder wall is much more relaxed.
Could this be the reason his bladder is so floppy? I don't know, but I'm going to assume so, primarily because I'm fresh out of other ideas. Fortunately, choline (the amino acid from which acetylcholine is made) is found in meat, egg yolks and fish oil - so I've given Raz a raw egg + a whole teaspoon of salmon oil this evening. Also, while surfing I fell over this post "Urgent help needed to EXPRESS a cat..." at HandicappedPet.net - see Fri Oct 20, 2006 7:16 am.
We have also decided to slowly ramp down the Bethanochol because (a) I don't think it's doing a damn thing and (b) he's been on it much, much too long. I will give him 5mg per day for the next two days and watch what's happening.
Raz tried to pee this evening just before expressing time, but after ages of squatting and scratching with no results he gave up.
Monday, June 20
Raz did two pees this morning by himself, one fairly decent one and one tiny one. At expressing time his bladder was definitely slightly less flabby at the start. I think I pretty much managed to empty him, though. I gave him a ¼ tsp of salmon oil with his breakfast.
We expressed him again mid-afternoon, then at midnight. At the moment it's very easy to start him off (which is absolutely wonderful!!), but I can't really get a decent flow going, just the annoying 'fast dribble'. I have noticed that he often has a tiny bit of pointed poo hanging out of his butt, which looks to me like the anal sphincter's 'pinching' ability is not (yet) working properly.
His Bethanochol is down to ¼ tablet twice per day.
Tuesday, June 21
The morning and afternoon expressing went pretty well. I would love to know if the salmon oil is having any effect. He is still on ¼ tablet Bethanochol twice per day.
I had a car accident this afternoon - parked by the bank, went in to use the ATM, and when I came out my car was half-way down the street. It turns out the hand-brake cable failed, and it damaged two other cars in its journey down the street (sigh). So now I have all the fun of vast amounts of insurance paperwork, ho hum.
Expressing Raz tonight was definitely more difficult than it has been over the last few days; he was more difficult to start off, and I couldn't get the 'fast dribble' really going. Even though it means I don't get him completely empty, I've decided to call a halt after 30 minutes, partly because he gets very restive after that and partly because my arms get so tired.
Wednesday, June 22
Two more 'poo presents' on the living-room floor this morning; again indicative that his pooing isn't working as well as it could.
I'm sorry to say that Raz is starting to tighten up again. Starting him off is getting increasingly harder, and the 'fast dribble' is back down to drop-by-drop. But this morning I noticed that the poor guy has some scabs on his belly (which is shaved from him recently having had an ultrasound) and it suddenly occurred to me that one reason for him struggling and squirming might be that my fingernails are digging into him (DUH!). So I rushed off to the bathroom and cut them shorter-than-short, feeling like a complete and utter idiot for not having thought of this before.
I think I will try again to contact the Handicapped Forum over here in Germany to see if a more experienced person might be up for a visit from me, just to have another 'take' on the situation, which is becoming increasingly depressing. I did register back in April, but never got an approval msg from the Moderator.
Midnight: no msg from the Sorgenfalls Forum yet, unfortunately. I spent most of the evening surfing looking for a Holistic Vet nearby, with mixed results. I can buy into acupuncture and homeopathy, but leeches ??!!
Expressing Raz was sooooo difficult this evening, I had to lean on him really hard for about 20 mins before the first drop appeared; then another 20 mins of hard squeezing to get about 60% of the pee out, drop by painful drop. We stopped well before he was empty because we were all three getting really tired and fed up.
I am having collywobbles about reflux as well as prostatitis - this amount of pressure just cannot help harming him. It is clear we cannot continue indefinitely like this - but yet, but yet, I really feel that if we could just find a temporary solution to buy him time, all would eventually be well! I don't know what to do.
I asked CarolC and Critters at the HandicappedPet.net forum if they know of any cats that have recovered all other functions with the single exception of urine retention. Am I kidding myself that he could recover? I need a temporary solution to buy him time to recover, say 3 months. I have looked into the idea of a cystostomy tube, but the surgeon will permanently suture the bladder to the abdominal wall to do this, I'm not happy about that.

Week 14: Thu.Jun.23.2011 — Wed.Jun.29.2011

Thursday, June 23
The Bethanochol is now down to ⅛ tablet twice daily, ie. 2.5mg per day. I do not see any difference in his bladder whatsoever.
Morning: expressing went very well, Raz was relaxed and just let me get on with it. Still "drop-by-drop", but at least no wriggling (I feel like such a idiot for not having thought about fingernails before now).
Afternoon: Something has changed again. Raz was up and down the trees in the garden like a monkey, doing huge leaps onto the trunks and almost running up the trees. I've seen him climbing the trees from time to time, but he's always been quite careful, eg. choosing to use the garden bench to get up onto the lowest branch and not really going high. But today was quite different. He was also running around the garden chasing his brother and generally in very high spirits.
The neighbours came over to complain about our cats crapping in their childrens' sand box. I felt really bad, that's a horrible thing to find in there. We talked about the problem, and I offered to make our own sand box (aka "kitty crapper") in our garden, plus buying them some pepper spray for theirs, and hopefully that might solve the problem. The neighbours had some extra sand left over and offered to let us have it, so Julian and I built a small sand box with a roof - and the boys love it, they christened it immediately!
Afternoon: expressing Raz was a joy and a delight, we were all done in 15 mins. Something is definitely changing. His penis came out at the start, and (relatively) large spurts of pee arced through the air - I haven't seen that happen since the very beginning. It then reduced to the "fast dribble", but it flowed out with very little effort on my part. Please, Raz, keep this up!
Evening: I completely forgot to give Raz his Phenoxybenzamine. Expressing him was a total disaster, we gave up after 30 mins having got exactly 5 drops out of him (sigh). He fought and struggled and complained, and was generally incredibly uncooperative. Is this because he didn't get any PBZ? I gave it to him at 2am (when I remembered).
Friday, June 24
As of today, Raz is no longer on Bethanochol; I am keeping the Phenoxybenzamine at the same 7.5mg level for the time being. His bladder feels just the same as it did when he was on the Bethanochol: firm at the start, going flabby about half-way through. I guess that means it isn't contracting as the volume of urine decreases.
Morning: a piece of cake. Again, Raz's penis came out and we got about half-a-dozen really good spurts going, then back to the "fast dribble", but it just flowed out. We were all done in 15 mins. It is still impossible to get him really empty because his bladder gets so flabby, which worries me, because it won't regain its proper tone unless I get it empty, but he gets so cross when I'm messing around for ages trying to empty it. I don't know if he's improving, or whether this is a result of no Bethanochol + a high Phenoxybenzamine dose.
Afternoon: Again a breeze. Please let this be the start of something good.
Evening: Absolutely impossible, unfortunately, Raz has clamped up again; expressing was a "drop-by-drop" exercise. After 30 mins, I had only got him about 50% empty, and gave up.
I have contacted a proper Animal Acupuncturist to see if anything more can be done.
Saturday, June 25
Today I am trying an experiment: I am giving Raz his phenoxybenzamine dose 3 times instead of twice, each dose half an hour before expressing him. Here's hoping I can find a link.
Morning: just like last night, drop by painfully slow drop. After 30 mins he was only 50% empty, and I gave up. It didn't help that Julian and I had an argument about when he is to die.
Afternoon: again, almost impossible.
Evening: yet again, seriously difficult. And that is the end of the phenoxybenzamine experiment - back to twice daily tomorrow.
The Acupuncturist Vet phoned me this evening, to say she was currently on holiday but would call me first thing on Monday morning. I have my heart in my mouth over this. If she can't help, then it's Game Over.
Sunday, June 26
Morning: Raz was very full, and his pee got going almost immediately with a few really good spurts; but when we got about halfway he started complaining very loudly, and twitched and struggled as if he was in serious pain. Julian held him down and I kept going regardless, but after the allotted 30 mins he was only half empty, and had seized up solid again - nary a drop to be seen.
Afternoon: Absolutely hopeless: after 30 mins we had managed to express about 10 drops of pee. Now I am getting worried about crystals forming because there is so much residual urine. Poor little guy, he clearly needs to pee - he dug about 5 holes in the garden this afternoon and tried to pee, but without success.
Evening: Surprisingly, Raz was not as full as I had expected, given our earlier failures. As usual, his nice, firm bladder turned into a flabby balloon after 10 minutes of massage; and after 35 mins I had managed to get exactly 6 drops of pee out of him. I could feel that he still had quite a lot left in there, but it was not going to come out. Yet another total failure.
I contacted Claudi over at Sorgenfells this evening, and (bless her heart) she has offered to take a look at Raz to see if she has any more success with him than I do. I will wait until I have spoken with the Acupuncturist tomorrow morning before getting back to her.
Should I put Raz back on the Bethanochol? Is this what's making him impossible to express? But he's been on it way longer than is normally recommended. What to do !?!?!?
Monday, June 27
Dr Elizabeth Lerke (http://www.tierakupunktur-lerke.de/) phoned this morning; she then came over to take a look at Raz - she asked me not to express him before she got here. We went outside for a cup of coffee and to allow her to watch Raz running around.
We took Raz upstairs, and she got him to run around and jump, etc., and then generally prodded and poked him (which he was very good about). She asked me to express him, with the usual result. Then she had a go herself, with the same zero result. She noticed that when she first manipulated him he had a bladder with no tone at all; but 10 mins later there was lots of tone! We then went into the garden for a chat and so she could watch Raz futzing. She is a practical person, full of common-sense. She suggested that rather than being unable to pee, Raz is holding onto his pee, perhaps because he is picking up on my/our anxiety, perhaps because he has some pain, who knows. She did not approve of my unilaterally stopping the Bethanochol because:
The autonomic nervous system (regulates functions under involuntary control) is divided into three parts: (a) the sympathetic (regulates 'stress' activities), (b) parasympathetic (regulates 'resting' activities) and (c) the enteric (regulates peristaltic waves).
The bladder and internal urethral sphincter are mostly composed of smooth muscle, which is under involuntary/automatic control; they receive innervation from both the sympathetic and parasympathetic systems.
The external urethral sphincter is composed of striated muscle, reinforced by the entire pelvic diaphragm; striated muscle is under voluntary control.
Storage phase: the sympathetic system relaxes the bladder and contracts the internal urethral sphincter, bladder neck and urethra.
Emptying phase: the parasympathetic system stimulates the bladder to contract and simultaneously relaxes the urethra; changes in the shape of the bladder during contraction mechanically pull the internal sphincter open. Voluntary contraction of the external sphincter and pelvic diaphragm can override this (up to a point).
Phenoxybenzamine inhibits sympathetic nerve activity, thereby reducing smooth muscle activity ⇒ reduced tone of the bladder + internal sphincter + urethra.
Bethanechol acts primarily by producing the effects of stimulation of the parasympathetic nervous system ... the primary effect of bethanechol is on the strength of contraction of the urinary bladder and peristalsis of the gastrointestinal tract. It increases the tone of the detrusor muscle of the urinary bladder, decreases bladder capacity, increases peristalsis and lowers the tone of the esophageal sphincter.
So giving phenoxybenzamine alone results in a floppy bladder with a relaxed internal sphincter and urethra; the bethanechol is needed to contract the striated muscles of the bladder.
Dr Lerke asked me to put him back on the Bethanechol at the original dose (¼ tablet three times a day) for the next week and then, if all goes well, start reducing the dose very slowly. She proposed that I do not try to express Raz any more, she thinks he has had enough of it and does not want it - he wants to do it alone! She said "You must stop trying to express him, he doesn't want it, he will not allow it. You have no choice." I was absolutely flabbergasted, I thought I was hearing her sentence him to a horrible death. She said I should monitor the bladder and, if it feels too full for more than one day, I should take him to the Vet and get him catheterised. I was rather doubtful about all this, so she suggested I take him to the Vet this afternoon and discuss getting him catheterised today. She seemed to think Raz would be just fine, but did emphasise the importance of monitoring the bladder situation because of the possibility of an UTI due to urine staying in the bladder too long. She didn't want to do anything to him - no needles, homeopathetic remedies, nix.
She did have a long talk with Julian, and persuaded him to give Raz another month before throwing in the towel, as she really believes all will be well.
So off we went to Vet #1 in the afternoon. Dr Sigloch had not seen Raz for a few weeks, and had a huge grin all over his face when he saw him running around with his tail stuck high in the air, jumping off the table etc. He lost his smile when he had a go at expressing him, because (a) he said the bladder had no tone at all, (b) the bladder was about half full, and (c) he failed to get a single drop of pee out of him. He then gave him a top-to-toe checkup, and pronounced him ridiculously healthy. We let Raz run around the room a bit while we were talking: I told him what the Acupunturist Vet had said, and he agreed with her that Raz was holding onto his pee, and also told me to leave the poor guy alone and let him get on with it himself! I told him about the bladder sometimes being firm and then going floppy, it was obvious he didn't believe me, so he had another feel of Raz's bladder and yes! there it was, a nice firm bladder. He said it was all very odd and peculiar. He said he didn't want to catheterise Raz today, he didn't think his bladder was full enough to warrant it. He gave Raz a Diazepam injection, and told us to go home and express him immediately while he was tranquillised. He said he would phone tomorrow morning to find out how things were going.
Back at home, Raz was clearly stoned out of his box and very happy that nothing Seriously Bad had happened to him. We tried to express him, but met with total failure - he scratched and bit and yowled and generally made it clear he was not allowing it. We let him out, and he spent the next hour going into the litterbox and doing pees all by himself, albeit only about a large tablespoon each time. At bedtime, we managed to express about half his bladder (which was only about half full anyway), at which point he got very nasty again, so we have decided to completely stop this pointless and future exercise.
Tuesday, June 28
Early this morning, Raz shot off to the kitty crapper, but got cranky when I tried to see what he was doing (sigh). The boys were running around the house and garden early on, but quickly subsided as the temperature climbed up to 33°C. None of them were much interested in food today, I guess because it is so hot.
Of course, I was hassling the poor guy a million times a day feeling his bladder and following him around; this first day I thought he was going to burst, it was very hard to leave him alone. He keeps on squatting and doing the tiniest little pees, but never seems able to get a decent quantity out.
The Acupuncturist Vet phoned, and she was delighted to hear that Raz wouldn't let us express him ☺ She said she would come again at the end of the week.
Vet #1 phoned: he laughed when we asked if the injection had really contained Diazepam, and he was also delighted to hear that Raz wouldn't let us express him, but wanted to do it himself.
Vet #2 phoned to say that he had tracked down a source of Dantrolene in Germany, but it would cost Euro 1,000 per injection (wowzah!!). He asked if I knew anyone in the UK who might send it over as a gift, but then I told him about current developments, and he was soooo pleased. He just kept repeating "Endlich! Endlich!" (Finally!)
The boys spent most of the day in the cellar, lying splayed out on the cool floor, looking very hot and bothered. I wish we had a water fountain so they could cool down (hmmm, there's a thought). I felt Raz's tummy a couple of times, but his bladder seemed fine, neither full nor empty.
Despite our previous decision, at bedtime we took Raz upstairs to express him, thinking "He must be full!" But amazingly, I found this teeny little thing nestling right up by his pelvis - I couldn't find it at first because I was looking for the usual big balloon. I gave it an experimental squeeze or two, just to see, but he started growling and thrashing his tail, so we left well alone. Oh happy, happy day - please, please, let this continue.
Wednesday, June 29
Another hot day, the boys weren't much interested in food or playing but lay around the fan in the hallway looking hot. I saw Raz peeing alone a few times in my newly seeded grass ☹
The Acupuncture Vet sent me an email and told me to go get "Opium D 30 Globuli (10 g)", and to give 5 Globuli to Raz once a day for 5 days.
At bedtime he seemed about 60% full, but a gentle massage + squeeze produced nothing but some fairly hard play bites, hind-leg kick-scratches and growls, so I left him to it. I would be a lot happier if he would let me express him. If he is still this full in the morning, then it's going to have to be done whether he likes it or not - the thought of a bladder rupture is just too scary.

Week 15: Thu.Jun.30.2011 — Wed.Jul.06.2011

Thursday, June 30
Morning: I left Raz to futz around in the garden for a few hours to give him time to pee, but unfortunately found he was about 80% full. However, amazingly he was quite happy to be expressed. His pee came noticably faster and in spurts (yay!) rather than the dreadful "fast dribble". He got very antsy about half-way through, and insisted on going into his litterbox and finishing the job himself.
Evening: he had more urine in his bladder than I was happy about, but I left him alone, per the Vets' advice.
Friday, July 01
After his morning run-round, Sir Raz came in for breakfast looking very pleased with himself - yup, his bladder was only about 20% full.
My estimations on how much urine he has in his bladder may be way off, as all I have to go on is the "big, floppy balloon" that I am used to feeling. I am working on "a normal, full bladder should feel about the size of a lemon". I have tried to feel one of the other cats, but they won't cooperate - all that my fingers can "see" is a sheet of steel ☹
Saturday, July 02
The weather has cooled down a bit, thank goodness. The boys are clearly happier, and running up and down trees like squirrels. Another good day: with mine own eyes (!!) I saw Raz pee a really decent sized amount twice. I've decided to try to stop hovering over him like a neurotic hen, and just check his bladder at bedtime - it was teensy!
Sunday, July 03
Again, a tiny bladder at bedtime.
Monday, July 04
Another fairly warm day (30°C); I braced myself to clean out the "kitty sand-box" - phew, did that smell! Anyone got any good tips for getting the cat-pee-pong out of sand?

Week 16: Thu.Jul.07.2011 — Wed.Jul.13.2011

Saturday, July 09
We reduced Raz's daily drug intake by one-third:
Date Drug Name Drug Qty Daily Frq. Dose Total Daily Dose
May.30 Bethanochol / Myocholine 10mg tablet (42mg wt) 3 x ¼ tablet = 2.5mg 7.5mg (31.5mg wt)
Jul.08     2 x ¼ tablet = 2.5mg 5mg (21mg wt)
      
May.30 Phenoxybenzamine / Dibenzyram 5mg capsule (16mg wt) 2 x ¾ capsule = 3.75mg 7.5mg (24mg wt)
Jul.08     2 x ½ capsule = 2.5mg 5mg (16mg wt)
Wednesday, July 13
Raz let me peek under him while he was peeing this morning. There is no question, his pee comes out at a good rate of knots to begin with, but fairly quickly slows down, then goes to a dribble, then drips. I felt him up afterwards, and his bladder still contained what I estimate to be about 20ml, ie. half-full. I am assuming that this is because his bladder muscles are weak.
Dr Lerke came over this morning; she is absolutely delighted.

Weeks 17 - 19: Thu.Jul.14.2011 — Wed.Aug.03.2011

Thursday, July 14
And so the weeks have dragged past, with very little improvement visible on a day-by-day basis, but looking back one can definitely say "Things are looking up."

Week 20: Thu.Aug.04.2011 — Wed.Aug.10.2011

Thursday, August 04
I reduced Raz's current drug intake by half:
Date Drug Name Drug Qty Daily Frq. Dose Total Daily Dose
May.30 Bethanochol / Myocholine 10mg tablet (42mg wt) 3 x ¼ tablet = 2.5mg 7.5mg (31.5mg wt)
Jul.08     2 x ¼ tablet = 2.5mg 5mg (21mg wt)
Aug.05     2 x ⅛ tablet = 1.25mg 2.5mg (10.5mg wt)
      
May.30 Phenoxybenzamine / Dibenzyram 5mg capsule (16mg wt) 2 x ¾ capsule = 3.75mg 7.5mg (24mg wt)
Jul.08     2 x ½ capsule = 2.5mg 5mg (16mg wt)
Aug.05     2 x ¼ capsule = 1.25mg 2.5mg (8mg wt)
It isn't possible to accurately weigh such small quantities, so I have taken to weighing the Bethanochol and the Phenoxybenzamine together and giving it to him. I am keeping on with the Diazepam until we run out, which won't be long.

Week 24: Thu.Sept.01.2011 — Wed.Sept.15.2011

Thursday, Sept 01
The six-month mark! Raz is still with us, and is still very slowly but surely improving.

Week 44: Wed.Feb.16.2012

It is now nearly 11 months since the accident.
Time has passed in its usual fashion; all of a sudden one day I realised there was nothing - literally nothing at all - wrong with Raz. His tail was 100% fine, his stool was 100% fine, his legs, *everything* was 100% fine. He was hunting and catching mice (and eating them); he was climbing trees; he was fighting with next door's bruiser cat; and best of all, he was eating like a horse. While Raz was ill his brother had grown quite a bit bigger, but he caught up fast - as of now Raz is larger and chunkier than his brother.

Week 44: Wed.Aug.07.2013

Two years and 4 months since the accident.
Raz's tail, Aug.04.2013 My previous entry on Feb.16.2012 was perhaps a trifle optimistic.
Over time it has become clear that Raz is rather only 99% fit.
Tail: We think his tail has a very small "dead" area in its middle, but we aren't completely sure about that. At any rate, it has a definite bend, rather than being straight. He also has a tendency to hold it at a slight angle to his hips, rather than straight outwards.
Urine: We think he may have a very tiny urine leakage problem; he licks his bottom much more frequently than the other cats do; but it might also be a habit that he picked up during his months of illness. He definitely has a truly bad attitude to anyone touching his bottom or his stomach, so clearly he didn't enjoy all that expressing-messing about.
Stool: If Raz gets his paws on kibble, he will wolf it down in a heartbeat, but it has a tendency to make him constipated. We also think he gets a bit constipated during the winter months, when he spends most of his time indoors because the weather is cold and wet, and so doesn't get much exercise.
These few minor things may or may not become issues as he gets older, but only time will tell. One thing is for sure: he definitely used up quite a few of his 9 lives.

The Wisdom of Hindsight ...

So the story has a happy ending. A few final comments:

What would I do differently?
Most importantly, I was an utter moron to have let my 8-month old uncastrated male kitten-cat out at night, fenced garden or not.
Diet:
I am absolutely convinced (as are my Vets now) that the one and only reason Raz never got crystals or any kind of urine infection is because he is 100% raw fed, and his urine Ph was always perfect. Please read Feeding Methods > Dry food: not recommended
Support:
My Vets were very supportive and keen to help; in the end Vet #1 published a research paper on Raz. He said that the vast majority of cats with this kind of damage do not live long enough to see if they would eventually get better, because the stress, cost and hard work are beyond most owners (but he didn't offer us any kind of discount!).
Luck:
I guess Raz is very lucky that (a) we aren't poor; (b) we work from home; and (c) I was absolutely bloody determined to do my very best for him.
And most lucky of all is that I found the HandicappedPet.net forum, and had the most fantastic support from the people here. I could NOT have managed without them; I think ignorance and despair would have gotten the better of me long before I came to the end of what was a very long and hard road.
Money:
I never added up the Vet bills because I just plain didn't want to know, but as a ballpark guess I'd say it was in the region of Euro 2,500+
The Awesome Threesome, Aug.04.2013 (Raz is at left)

 

 

The End of his Tale – Apr.25.2014

Raz, Jun.06.2011 We buried Raz this afternoon. He would have been four this June.

He had a 6.5cm dia. abdominal lymphatic cancer tumour, plus other complications. None of it was related to his tail trauma.

He will be sorely missed. He was a really, really cool cat.