One Wrong Step

D. E. Larsen, DVM

It was almost 8:30, and Debbie hadn’t come through the door yet. This was most unusual for her. I was mostly relaxed on arrival times for work unless someone took advantage of the fact. But Debbie had been working here since her senior year, and she was never late. We were concerned for her safety more than worried about her being tardy.

It was somewhat of a relief when she pulled up to the front door, another thing not allowed. But she got out of her car and reached into the back seat and pulled out a cat carrier. Her hair was not combed, and she was still in her barn clothes.

“I’m sorry, but Simba got stepped on by Dad’s horse, Rocket,” Debbie said while trying to catch her breath. “I have been all morning trying to get him into this carrier. He is still walking, but I think it is a bad injury.”

I took the carrier from Debbie and set it on the exam table. “I will get a look at him and get a set of x-rays,” I said. “You can go home and get cleaned up and relax a little. By the time you get back, I should have things figured out.”

“Thanks,” Debbie said as she opened the carrier door to give Simba a soothing pat on the head. “He is terrified and pretty painful, don’t let him bite you.”

“I will give him a little Ketamine,” I said. “That will give him some pain relief and allow us to get a set of pictures without a struggle. You hurry along now, we have a slow morning and will be able to get him taken care of without changing too much in the appointment book.”

Simba was a big cat. He was a Siamese cross, and like my Charlie cat, hunted all the time. This was an unfortunate accident. I drew up a small dose of Ketamine and gave it by IM injection. Then waited a few minutes for it to take effect. It was easy to tell when it was taking effect because the cat’s pupils would dilate completely.

When I was able to pull Simba out of the carrier, I ran my hand down his spine. It was fine until I reached his tail. Rocket must have stepped on him right at the base of his tail. His tailbone was completely depressed into the floor of his pelvis. He would probably have nerve damage to the tail and maybe to his rectum, but my primary concern was with his colon and his pelvic urethra.

We got a set of x-rays, and while they were developing, I did a rectal exam on Simba. With my finger in the colon, I could push the tail bone up into a normal position. That would need to be wired into place. I have seen some tails return to function after a few weeks or months following such an injury, but most are paralyzed. It was not worth the wait unless a client was really hung up about not taking the tail off. The colon seemed to be intact on the digital exam. We would wait to see what the x-rays said.

Debbie popped back through the front door just about the time I put the x-rays on the viewer. No fractures, only the displaced tail bone. The colon looked okay. Then the problem came into view. The bladder was lying in the ventral abdomen, with no attachment to the pelvic urethra. The tail bone had been pressed down against the pelvic floor, and it amputated the bladder from the pelvic urethra.

“Can you fix that?” Debbie asked, with some tears welling up in her eyes. She had seen enough surgery to know this would be difficult, if not impossible, repair.

“I can try,” I said. “But to be honest, it is probably not going to be something I can do. I am not even sure that Dr. Slocum could do this.”

“Taking him somewhere else is not an option,” Debbie said as a tear spilled over and ran down her cheek.

“I will open him up and take a look,” I said. “There might be another way to fix him. When cats are plugged, we sometimes need to do a perineal urethrostomy. Looking at this picture, that might not be possible. We could maybe do a prepubic urethrostomy. Just bring the bladder neck out through the abdominal wall on his posterior abdomen.”

“Would he be able to pee okay?” Debbie asked.

“That will depend on what is left on the end of his bladder,” I said. “If we were to get lucky, he could even have control of his urine. If not, he might just dribble urine all the time. But it will give him a chance at survival. We can always put him to sleep at another time if it becomes obvious that he is not going do well.”

“Okay, let’s go ahead and do what we can to save this guy,” Debbie said.

When multiple surgeries are going to be needed, the rule of thumb is to do the procedure that will do the most good first. In Simba’s case, that meant we would fix the bladder first, then worry about securing the tail bone and the amputation later. Probably, that would mean tomorrow.

With Simba under anesthesia and on the surgery table, I opened the abdomen with a posterior midline incision. Looking at the bladder, I am not sure one could have done a nicer amputation with a scalpel. It was severed right at the prostate, we could probably expect urinary control with a prepubic urethrostomy. The pelvic urethra was far enough into the pelvis that reattachment was not going to be an option.

So I brought the neck of the bladder out through the abdominal wall and made a nice stoma to prevent scar tissue closing the stoma. After closing the abdomen, we had ample time to turn Simba over and do the surgery to wire his tail bone in place, and amputate is tail.

Now it only remained to see how his bladder would work and if he could deal with peeing out his belly wall. Some animals could have a problem with urine scald with his urine soiling the skin around the stoma. But the cat is fastidious enough that we should not have that problem.

Debbie was pleased with the fact that Simba had a new lease on life. Simba recovered well and went home with Debbie that evening. When he returned in two weeks for suture removal. The stoma was healed well, and Simba was keeping himself clean.

“Does he have an awareness of where he is peeing?” I asked.

“I think he has learned already,” Debbie said. “At first, he was a little surprised when he would squat to pee, and it would come out his belly. But now, he just lowers his belly down and lets it go. He seems to have complete control. We have not noticed him leaking urine anywhere. Mom is pleased as can be. So are Simba and I.”

Simba went on to live a long life. I had worried and warned Debbie about chronic bladder infections. Still, Simba must have had enough urethral structure to prevent that problem.

Photo by Janko Ferlic from Pexels