Visiting Vet: Gemma’s dilemma

Urinary blockages are rare in female felines, but they do happen.

A sensitive or anxious cat may be more susceptible to health issues. —Mikhail Vasilyev

Thursday is my day providing “Urgent Veterinary Care” on the Vineyard. Despite the fact that I haven’t taken on new clients in years, for a 24-hour period each week, I try to assist anyone needing immediate help with a pet. This might include Islanders whose regular veterinarian is unavailable, seasonal residents whose animals get their routine care off-Island, and visitors just here for a few days. Since our pandemic pet and people population boom, and the retirement of several local veterinarians, this also means local folks whose pets simply haven’t been able to get a spot as regular patients with us few remaining local docs.

My first phone call one Thursday morning was sort of all of the above. Gemma, the cat in question, had only recently moved to the Vineyard and had never seen a local veterinarian. The person calling me also had a dog, but that dog’s veterinarian was off Island. The cat officially belonged to the caller’s mother, an Islander whose previous pets had been cared for by an Island veterinarian. . .  who had no open appointments available . . .and Gemma appeared to be in distress.

“What’s going on?” I asked. “I think she has some kind of urinary tract infection or cystitis,” the caller replied. Gemma had been straining to urinate. She had vomited once and passed a small amount of bloody urine. I relaxed. Dysuria and hematuria. Those are the technical terms for difficulty urinating and bloody urine. If Gemma had been a male cat, especially a neutered male, I would have been more worried. In male cats these signs often indicate urethral obstruction, a dire emergency that we refer to simply as being “blocked.” But in female cats, blockage is rarely a concern. Let me explain.

There are a number of conditions that can create inflammation in a cat’s bladder. In younger cats the most common is Feline Interstitial Cystitis — an inflammatory disease of unknown cause which may be related to stress. In older cats, bacterial urinary tract infections are more common. Bladder stones and tumors are other abnormalities that can occur. Dietary imbalances have also been implicated in some feline lower urinary tract problems, especially years ago when our understanding of feline nutrition was less advanced. The important point is that inflammation, regardless of etiology, can cause an accumulation of  . . .  stuff. Cells, protein, crystals, debris. Stuff. Stuff that can get lodged in the urethra — the narrow tube that carries urine from the bladder out of the body. Male cats are particularly at risk for blockage because their urethras take a long, tortuous, S-shaped route through the penis. In female cats the urethra is shorter and wider, with a more direct route straight out, so debris doesn’t get lodged there.

Except Gemma. I took Gemma out of her carrier and palpated her abdomen to assess her bladder. It was big. Abnormally big. I pressed gently. In blocked male cats, one of our diagnostic tools is simply to see if  we can “manually express” urine. In other words, we squeeze. Carefully. Very Carefully. If urine comes out in a decent stream, that cat is not blocked. If you get a drop or two, or nothing at all, Tom is blocked and it’s time to try to flush out his urethra with a “tom cat” urinary catheter. Easier said than done. . . but that’s a whole different column. When I squeezed Gemma’s bladder, a trickle of red urine dribbled down her hind legs,  but her bladder was still distended and firm. I was no longer relaxed.

Once, 40 years ago, as a very young doctor, I was presented with Oopsies, a blocked male cat. I palpated his bladder and was able to express a very small amount of urine. I tried again, very gently. Then suddenly, pop. The previously balloon-like bladder I had been feeling disappeared. Oopsies. I had ruptured his bladder. It’s easier to do than you might think. In blocked cats the bladder may be stretched abnormally thin and often has been under pressure for many hours before the owner recognizes the need for emergency care. After a moment of disbelief and agitation, I regained my composure, called the owner, and took Oopsies to surgery. I repaired the bladder, relieved the blockage, and treated the underlying disease. Oopsies recovered completely. I never did. To this day when I palpate a tense distended cat bladder, I recall in vivid detail how it felt that moment when. . . Oopsies.

But female cats don’t block, right? Not exactly. I put a teeny bit more pressure on Gemma’s  bladder. Suddenly urine was flooding my exam table. As we moved her away from the puddle, I saw a small lumpy tan object about the size of a seed pearl in the pool of pee. Gemma was that rare female cat who had experienced a blockage from a small bladder stone lodged in her urethra.

It was easy to help Gemma empty her bladder after that. A radiograph made sure there were no other visible stones. We discussed additional diagnostic and treatment options with her owners and decided on antibiotics to cover for bacterial infection, medications to reduce inflammation and discomfort, fluids to rehydrate and “flush out” her system, and a change in diet to one specifically designed for feline lower urinary tract diseases. We also sent the stone for analysis which may give us more information about why she got it in the first place and what else we might do to prevent any recurrence.

Reviewing Gemma’s previous history, it became clear she is a sensitive soul, highly susceptible to stress. In fact, she had almost been euthanized at the off-Island shelter due to her difficulty adjusting. Lucky girl, she has found a wonderful home now. I advised her owners to explore ways to reduce her anxiety going forward. In 42 years of practice I had never seen a blocked female cat before. It’s time to go reduce my own anxiety with a cup of tea and a crossword puzzle.