How to tell if male cat is truly having a urinary block?

[6CatsandCounting]

Hello all,

some background info on my cat:
Neutered Male 14 years old named Pipp
He did a blockage years ago when he was 3. It was easily removed and he spent one night in the hospital. Since then he’s always been on C/D until a few years ago when he had signs of a food allergy or IBD. However the diets he was switched to are on the S/O index. He also eats wet twice a day and prescription kibble is freely available.

anyway that brings up to todays issue. Yesterday he became ill and had multiple bouts of vomiting and diarrhea. He then did not drink or eat all day. He just hid. This has happened once before last year and we had spare cerenia on hand. So after waiting it out yesterday I gave the nausea medicine. That did resolve the vomiting however he still wouldn’t eat or drink and stayed under the bed. This morning we went to the vet because things were not getting better. He got a cerenia injection and an antacid injection. We did X-rays to make sure he didn’t have something more going on. He had just gotten blood work last week for his thyroid so the vet didn’t think we need to run more labs. Anyway, because of the hiding he hasn’t gone to the bathroom since at least yesterday morning. The vet said his bladder was full but on X-ray he didn’t appear to have urinary stones or crystals visible. She basically said if he doesn’t pee by tonight to just go to the ER and to update them.

Well at this point he still hasn’t peed. He is still slightly sedated from having to take gabapentin this morning for the vet exam because he’s reactive. I called the vet to update them and got his records in case we do end up at the ER. He’s been drinking and more interested in food and hasn’t been hiding but he’s still just laying around. He won’t go to the litter box at all. Previously when he was truly blocked he was straining and trying to pee. Right now there’s no signs of that. He just doesn’t feel well and wants to rest but I’m worried.

I already spent $400 today and it sucks to perhaps spend a lot more at the ER if he isn’t blocked, but I obviously will if it’s life threatening.

thoughts?

Should I assume the worst that he is blocked? Should I wait overnight to see if he pees once the gabapentin wears off? I’m just scared to wait since he hasn’t gone in almost two days but he also hasn’t even tried to?

 

[Margot Lane]

Two days seems an awfully long time to me…..

 

[FeebysOwner]

Hi. There can be severe swelling in the urethra - without crystals/stones in his bladder. I don't know how much that would have shown on an x-ray, but I thought it would have been apparent at least to some degree. Did the vet mention anything about that?

Did they empty his bladder at the vets? Perhaps, he hasn't had enough to drink to prompt him to want to pee. But, that seems like a long stretch.

 

[6CatsandCounting]

Hi. There can be severe swelling in the urethra - without crystals/stones in his bladder. I don't know how much that would have shown on an x-ray, but I thought it would have been apparent at least to some degree. Did the vet mention anything about that?

Did they empty his bladder at the vets? Perhaps, he hasn't had enough to drink to prompt him to want to pee. But, that seems like a long stretch.

Thank you for this info- honestly at the appointment this morning my vet didn’t seem to concerned about a blockage. More so was just like “oh it was full so make sure he is peeing this evening” I do wish looking back they had tried to empty it or thoroughly checked. I guess since at that time the vomiting and not eating was the primary concern it was over looked.

i am now at the veterinary urgent care. I didn’t want to risk waiting in case something happened overnight since there isn’t a 24/7 vet locally. Hopefully here they can confirm if he is blocked or not and empty his bladder.

 

[FeebysOwner]

i am now at the veterinary urgent care. I didn’t want to risk waiting in case something happened overnight since there isn’t a 24/7 vet locally. Hopefully here they can confirm if he is blocked or not and empty his bladder.

Please keep us posted.

 

[silent meowlook]

Go to the ER now. Hopefully he has urinated in the closet, but if not, he must be seen. I am surprised with his history of an obstruction and a large bladder on X-ray that the vet was not concerned. A urinary blockage will not show up on X-ray.

 

[silent meowlook]

So glad you are at urgent care with him. Please update when you can.

 

[6CatsandCounting]

Positive update! The urgent care team was so kind, I had never used them but they were only 5 miles up the road so the trip was very quick.

they thoroughly felt his bladder and expressed some urine. They assured me his wasn’t blocked and his urethra looked healthy. It was noted he was very full but the bladder still was soft. Vitals were all good and stable. Although they weren’t sure why he was holding urine, they said he was definitely able to pass urine fine. The vet didn’t even make me pay a fee since it was a quick exam 🥲 really truly did not expect that.

Anyway as soon as we got home Pipp went in the box and peed. Of course! After worrying me for two full days!

The nurse I spoke to there did mention that some cats on Prozac do hold urine at times so this is a possibility for why he wasn’t going? Anyway I’m grateful that them stimulating his bladder helped enough for him to finally go to the box.

I never thought I would be so happy for a cat to pee.
I’m really hoping we’re out of the woods now. He’s not 100% himself given the GI upset he’s been having but the injections today did seem to help and thank god he’s peeing!

 

[FeebysOwner]

That's wonderful news - and great care/compassion by the urgent care group!! Has Pipp recently been put on Prozac (sorry if I missed that)? If so, did they say that holding urine is a symptom that dissipates over time? I guess just something to watch from now on. Could his vomiting also have been brought on by it, if it is a new med for him?

As far as the Cerenia - and, maybe the antiacid too - the injection usually only lasts for about 24 hours, so that being the case, hopefully you have back up meds to give him if he should need them tomorrow.

Post back on his progress!!

 

[silent meowlook]

I have heard of Prozac causing urinary retention. If he has just started this medication, it may not be the best for him.

Double check that the litterbox is okay and nothing has changed like the litter or location.

How recently was he blocked? There is such a thing where the bladder can, if over extended for a great length of time have muscle damage.

Anyway. Glad he peed!

 

[FeebysOwner]

How recently was he blocked?

To answer your question, in case it helps any:

He did a blockage years ago when he was 3.

Pipp is now 14.

 

[6CatsandCounting]

That's wonderful news - and great care/compassion by the urgent care group!! Has Pipp recently been put on Prozac (sorry if I missed that)? If so, did they say that holding urine is a symptom that dissipates over time? I guess just something to watch from now on. Could his vomiting also have been brought on by it, if it is a new med for him?

As far as the Cerenia - and, maybe the antiacid too - the injection usually only lasts for about 24 hours, so that being the case, hopefully you have back up meds to give him if he should need them tomorrow.

Post back on his progress!!

So the Prozac was somewhat newer medication for him. We had started it back in late May or early June for aggression and urine marking that had started after we moved last. He takes 2.5 mg once a day. He is also on methimazole for hyperthyroidism.

Everything was health wise ruled out for the urine marking. Despite many attempts to correct it without behavioral medication the Prozac was the only thing that resolved it. He really didn’t have noticeable side effects from it, at first he was a bit dazed but he adjusted and became calmer and stopped marking and fighting with one of our other cats.

Looking back maybe I should have tried to pay more attention to how often he was peeing in the box but it appeared to be at least daily. Now with everything going on I’m sort of wondering if his sudden GI upset holding urine and sleepiness could be related. Not really sure if side effects can occur after being on Prozac for a few months though?

He did at least use the box again last night. He still seems reluctant to truly eat. He’s been grazing here and there, but it’s not like his usual apetite which does concern me. I do have cerenia pills though and he got one this morning. I also have Pepcid on hand to give him.

Naturally when I tried to call his primary today to speak with his vet I was told to “follow up with urgent care since they saw him last” by the receptionist- despite explaining that urgent care said he was stable, that he was not blocked, and they said to follow up with our primary today and discuss his symtoms and medications with our normal vet. The receptionist seemed confused as to why they didn’t have records from urgent care, even though I explained we didn’t even have to pay to be seen because there wasn’t a need for a real exam

truly frustrating considering he was just seen at his primary yesterday morning and i was there for two hours, spent $400 dollars, and the vet instructed us to call today to update her. Obviously if I’m able to speak with his vet I would like to discuss the possibility of some of the symptoms being related to the Prozac perhaps? Or even if we should get blood work done now and maybe try an appetite stimulant? I may try to email or call them later. I’m sort of just venting now, but I can’t believe I was told yet again to go back to urgent care despite doing so last night. I literally just wanted to talk to the doctor

 

[fionasmom]

I am glad that you were able to get help for Pipp! Once in a while I hear one of these stories about a vet refusing to see a patient who received ER care and it is very frustrating, not to mention illogical. You have paid a current bill to the vet and have just seen them, so this is not a request for advice on a cat that they have not seen in a long time. I would really push this with them and insist on their follow up. Most ERs, human and veterinary, are not in the business of follow up once they have stabilized the patient.

 

[6CatsandCounting]

I am glad that you were able to get help for Pipp! Once in a while I hear one of these stories about a vet refusing to see a patient who received ER care and it is very frustrating, not to mention illogical. You have paid a current bill to the vet and have just seen them, so this is not a request for advice on a cat that they have not seen in a long time. I would really push this with them and insist on their follow up. Most ERs, human and veterinary, are not in the business of follow up once they have stabilized the patient.

Yeah this is exactly the thing that annoyed me. I really understand that they are probably busy and may not have appointments today. Which I wasn’t even trying to bring him back yet. Rather I just wanted to discuss his medications and see if maybe it’s worth trying an appetite stimulant now? The other issue at hand is I don’t think urgent care would want to adjust the Prozac dosage since it’s prescribed by my primary vet. At least that’s what I gathered from yesterday when I was there. They basically said to talk with my primary about it Especially because Prozac needs to be tapered and monitored if we were to discontinue it. Obviously urgent could can’t oversee a long term taper.
kind of just left feeling confused by that and thinking that after we get through whatever is going on that I may switch to a different vet practice.

 

[fionasmom]

I don’t think urgent care would want to adjust the Prozac dosage

It would be very unexpected, and maybe not even the best thing, if an ER wanted to get involved in the dosage of a medication like Prozac. They probably have no interest in doing that.

I may switch to a different vet practice.

If there is any other convenient practice, this might be a good idea. nextdoor.com is a good site to ask other people local to you for recommendations.

 

[FeebysOwner]

Prozac can take 4-8 weeks to reach its peak benefit in cats - I suspect that might also be the case with certain side effects. Once you get a hold of your vet, discuss this with them. Maybe the dose could be lowered a bit to see if that helps.

When was his thyroid level last checked? Could it be possible his dose needs to be lowered? Side effects of too much is lethargy and lack of appetite, although I am sure other side effects are possible.

You might ask the urgent care center if they made any notes at all that you could have or that they could send to your vet. In the meantime, call your vet back and specifically tell them that your vet asked for an update and that is what you are trying to do. Don't take no for an answer - tell them to talk to the vet and let them make the decision about calling you back. If that doesn't work, find out your vet's schedule, and go to their office in person and ask to speak with them.

 

[silent meowlook]

When you call your primary vet, ask to speak to one of the technicians. They will better be able to help you and get you to speak to the veterinarian.
Urgent cares don’t want to do follow ups, neither do ER vets,

 

[6CatsandCounting]

Prozac can take 4-8 weeks to reach its peak benefit in cats - I suspect that might also be the case with certain side effects. Once you get a hold of your vet, discuss this with them. Maybe the dose could be lowered a bit to see if that helps.

When was his thyroid level last checked? Could it be possible his dose needs to be lowered? Side effects of too much is lethargy and lack of appetite, although I am sure other side effects are possible.

You might ask the urgent care center if they made any notes at all that you could have or that they could send to your vet. In the meantime, call your vet back and specifically tell them that your vet asked for an update and that is what you are trying to do. Don't take no for an answer - tell them to talk to the vet and let them make the decision about calling you back. If that doesn't work, find out your vet's schedule, and go to their office in person and ask to speak with them.

Thank you for this! I felt a little crazy thinking to myself about calling again and pretty much insisting that the vet calls me back.

His thyroid medication hasn’t been increased in probably a month or two now. He was borderline high when we first started medication last fall to correct it. His starting dose was very conservative at 1 mg and from there increased in small doses to not overload him. the most recent increase was to 2.5 mg twice a day. Since starting it we’ve gotten a full panel ran basically every month to three months. So we’ve monitored closely and increased very slowly.

Most recent blood work was done on the 22nd so within the last week. This is why when we were at the vet yesterday morning the doctor felt that blood work wasn’t necessary to have done.

Bit of an update:

this whole health episode really confuses me. In the past with his GI issues he would still have an appetite but would either have diarrhea or vomit. He’s never just became reclusive and flat out uninterested in eating. Thankfully he’s been out and about more. He hasn’t vomited since the cerenia was initially started. But he still licks a lot when I present food. I can’t figure out if he’s maybe having oral pain or trouble swallowing? Sometimes he’s interested in what I present him, I’ve been trying a whole variety of thing but he just sort licks at food. I’ve been giving him primarily mashed up pate but I know hes not getting enough calories

I did get to speak with the vet yesterday evening at least and she wasn’t too interested in the possibility of his symptoms being perhaps related to either of his current medications.

She did prescribe an appetite stimulant- however it is not the one I’m familiar with, it’s a new one. It’s called elura and of course after reading side effects I got too nervous to give it last night.

The reason was I saw that it can lower heart rate and blood pressure for four plus hour after dosing. Of course I got scared seeing that some cats have died due to this or ended up unresponsive and at the ER. I wanted to make sure I was able to closely watch him and have a vet reachable if he was to have a serious side effect arise. I think I’m going to try giving it this evening when the urgent care nearby is open just to be on the safe side.

Kind of debating trying to get him back into the vet tomorrow for blood work at least, having his mouth and such checked out and considering discussing ultrasound or something. His X-rays were normal but there’s clearly something not right.

 

[FeebysOwner]

Although I believe I have heard from some others that Elura doesn't seem to be as effective as perhaps mirtazapine (or the transdermal Mirataz), the thing I specifically did not like about it is that it is supposed to be given on an empty stomach 30 minutes before a meal, due to the fact that giving it with a meal may delay the effects or reduce its efficacy. First off, it is a liquid, and secondly I would image it - like most meds - doesn't taste very good. If it were me, I would ask for Mirataz, instead. When my cat was getting Mirataz, it seemed to help at half dose and I only gave it to her every other day. Dosage of Mirataz is kind of an experimental thing to see how much/how often works for each individual cat.

Having his mouth checked out is probably a good idea.

 

[6CatsandCounting]

Yeah I was really expecting it to be mirataz. I’ve used that with three other cats at points throughout the years and would have been more comfortable with it. I’ve had decent success with Mirataz although like you mentioned figuring out the dosage can be tricky. My partner was the one who spoke with the vet yesterday and I guess from what he told me the vet said she preferred Elura for whatever reason?

Last night I did try giving it in tuna juice hoping Pipp would at least lick it since he did take a bit of it before I put the medicine in. But it was a failure.

After that I ended up reading about it and seeing it had mixed ratings- then I saw the heart rate and blood pressure side effects which made me decide to hold off. Especially since forcing him to take liquid medicine usually results in him gagging and trying to vomit. Even right now having to pull him multiple times a day is a challenge and he ends up gagging.

I tasted a dab of the Elura and it’s definitely unpleasant and bitter, of course! I may try to put it in an empty capsule like I’ve seen others mention on here, but he’s supposed to be taking 0.5 mls which maybe hard to try to fit in one.

I did call the vet again just now, today they’re fully booked but I was told to call tomorrow morning when they first open to get one of the “urgent same day” appointments there. At this point I’m more worried on trying to figure out why he won’t eat and has been so off rather than just treating the symptoms. Really nervous it could be cancer or something, although there wasn’t any blood markers or signs on the X-rays.

Hoping it’s something treatable at least.