Apache’s Problem 

D. E. Larsen, DVM

I had just settled into bed, glancing at the clock. It was just after 11:00. The morning will come soon enough. I thought as I rolled on my side and closed my eyes. The phone was quick to jar me back to my senses.

“Hello, this is Dr. Larsen,” I said into the phone.

“Hi Doc, this is Ed Collins. I think Apache has a problem. I have been watching him all afternoon, and he has been straining to take a crap, and nothing comes out. Now he is yowling, quite loud. I think you should get a look at him,” Ed said, very matter-of-factly.

“Ed, I think we should have looked at him this afternoon.”

“I know Doc, it’s late, but I would hate to have him suffer all night. Can we come down?”

“Don’t come too quick. I’m home in bed, and it is going to take me about 20 minutes to get up, get dressed, and get to the clinic. I will see you and Apache then. And Ed, you know there is an emergency fee at this hour?”

“I understand Doc, we will see you in 20 minutes.”

Apache was large gray tabby cat and probably the biggest cat I looked at in the practice, and he weighed about twenty-seven pounds. Ed thought the world of him and was proud of his size. He did not tolerate any discussion on weight loss. “He has all the neighborhood cats scared to death, and he beats the tar out of them all.”

Ed was a little man, well in his eighties, mostly bald with just a few gray hairs remaining. His nose was the most prominent feature as it was large enough to make one think he would be a large man if he would grow into his nose. Ed always carried Apache when he came into the clinic, and Apache was all he could handle. He would walk into the clinic holding Apache across his chest, leaning back, to keep from falling forward. We would usually lead him to the exam room right away, and he would flop Apache on the table, straighten up and take a deep breath.

When I pulled up to the clinic, Ed leaned against the door for some support, holding Apache as best he could. I would bet that he had been there for a good 10 minutes.  

“Good evening, Ed,” I said as I unlocked the door. “Let’s take him right on back to the treatment table,” I said as I reached over the counter and switched off the alarm.

It was all Ed could do to reach the table with Apache. He lowered his shoulder, and Apache slid off onto the grated surface. Apache let out a low growl when he hit the table.

“Has he been painful,” I asked.

“Earlier today, he was straining a lot, and once in a while, he would yowl. But this evening, he has been pretty uncomfortable and growls every time I touch him. Really loud when I touch his belly.”

I did a real quick exam to make sure Apache was not critical yet. His hydration was satisfactory, and his membranes were pink with normal capillary refill. Heart and lungs sounds were normal. I took the temperature with an ear thermometer, normal. I stood him up on all fours and cupped his abdomen in my hand. Will, I sort of cupped his abdomen in my hand. 

I could feel his entire abdomen with one hand in a typical cat, and Apache’s belly was a little too large for that kind of palpation. With a slight push on the posterior abdomen, I could bump his distended bladder. By Apache’s loud protest, it was also a painful bladder.

“Ed, Apache has a urinary blockage, and he can’t pee. The straining you witnessed this afternoon was him straining to pee. It is a common mistake for people to think he is straining to have a BM.”

“What do we need to do, Doc?”

“I will sedate him and flush out his urethra. This bladder is painful enough that I will put a catheter in his bladder and put him on fluids for the night. He will need to stay here until morning.”

“No, that ain’t going to work, Doc. Apache has never stayed away from home. I am not going to leave him overnight.”

“This is a serious condition, Ed. This is something that could kill him at the worse, or if his urethra gets damaged, it could require some major surgery.”

“I am not going to leave him, Doc!”

“Okay, let me see if we can get lucky, and I can flush his urethra with him awake. If so, we will empty his bladder, give him some subcutaneous fluids, and plan to recheck him first thing in the morning.”

The good thing about fat cats is that they all have a flat back. I rolled Apache onto his back, and he was sort of like a turtle. He laid there, still as could be with all his legs spayed out to the sides. It probably took some pressure off his bladder. He was really relaxed. 

I filled a 12cc syringe with saline solution and attached a blunt 23 gauge curved lacrimal needle. I laid my forearm along Apache’s chest and abdomen to provide some restraint. With my thumb and index finger of my left hand, I pushed the skin of his prepuce down, exposing his penis. The penis of the cat is short and pointed, with a small urethral orifice. That small orifice is the cat’s downfall. When crystals form in the urine, they will plug the small orifice. Once in a while, there will be a stone, but there are usually just crystals, almost sand-like.

I could see a small glob of crystals on the end of the penis. We were maybe going to luck out. I washed them away with a squirt of saline from the syringe. Then, carefully, I inserted the tip of the blunt needle into the urethra.

Apache did not move, almost like he knew what he needed. I flushed some saline into the urethra, and I could feel the plug of crystals loosen. I pushed the needle in a bit further and flushed again. With that came first a bunch of sand and then a big squirt of urine that flew halfway across the room. I reacted a little, making sure the stream of urine missed me. 

Ed jumped back in amazement. “Wow, he really had to pee.”

“That was easy. Most cats aren’t this good. I will put a catheter into Apache’s bladder to make sure I can empty it. Then I will take it out, give him some fluids and send him home. But you have to promise that you will be back in the morning and plan to leave him with us for most of the day.”

I flushed a half cc of lidocaine into Apache’s urethra and then easily slid a tomcat catheter into his bladder. I withdrew over nearly six ounces of urine from Apache’s bladder. Then I instilled twelve ccs of saline into the bladder and sort of rolled Apache back and forth a few times before withdrawing the saline. I did harvest a good collection of crystals with the saline.

***

Apache was feeling much better when Ed brought him to the clinic in the morning.

I palpated Apache’s bladder. It was somewhat thicker than normal, but a little squeeze caused Apache to pee. There was no pain response to the urine flow. When I put a drop of the urine under the microscope, no crystals were present.

“I think you got lucky, Ed,” I said. “I think Apache is free to go home, and I will send you home with a special diet to keep these crystals from forming again.”

“Now, Doc, I don’t want you sneaking no diet food on me that will cause Apache to get skinny,” Ed said. “There are a couple of new cats on the block, and Apache needs all the weight he has to teach those guys who’s the boss.”

“Okay, there are a few foods to choose from that will solve the problem,” I said. “The best one to start with is S/D. It will help dissolve any crystals that are present. Then we can change to C/D or W/D. For cats that are a little overweight, I like to use W/D.”

“That’s fine, Doc,” Ed said. “I will take a small bag of S/D, and then I will pick up a bag of C/D when I need it. I know you think Apache is

overweight, but he is just a big cat. And he needs that extra pound so he can continue to terrorize the other cats in the neighborhood.”

Ed and Apache went home with a four-pound bag of S/D cat food. I never saw Ed come back for more food. Apache never had another urinary issue, but he was still grossly overweight when Ed passed away.

Photo by Callum Wale on Unsplash.