Update on Rigel and response from DjurAkuten

Update: When I first wrote this post I kept all clinic names anonymous. I am now un-anonymising one of the clinics (DjurAkuten), where this whole chain of events was triggered in the first place and which is now trying to claim that Rigel was already sick/had a flaccid bladder when we brought him in for a routine surgery as a healthy kitten despite their own records stating otherwise.

Note: Veterinarian clinic/hospital names in this post have been changed. If you know the vets in Stockholm you may be able to easily get an idea of which places I’m talking about, and if you want some clarification you can message me in private. I wasn’t sure if it was right to include real names here.

This is Rigel on his trip home to us from his breeders in Norrköping. He was 3 months old and the nicest of cats. He slept quietly through the long train ride to Stockholm. When we got home he walked out of his carrier, sniffed around, and claimed the house - and us - as his own.

Here I am channeling Overly Attached Girlfriend on his first day home:

Rigel was the most amazing kitten. He’d follow us around everywhere, do flop-downs and chirp at us; he talked to us, developed his own quirky habits and personality. He was one of the best things that’s ever happened to me.

On February 12, at a bit over 6 months of age, Rigel had his neutering surgery. He was born with a condition called “cryptorchidism”, which meant that his testicles hadn’t descended. This didn’t cause him any health problems, but it did mean that the neutering surgery would be a little more involved - it would more closely resemble spaying a female because the surgeon would have to go into the abdomen to retrieve the testicles. Nevertheless, it’s meant to be very safe and routine. We took him to a clinic a little north of T-Centralen that we heard great things about (even though we live South of the city), DjurAkuten. I was worried as you would be with any surgery, but this is done all the time and we heard good things about them.

DjurAkuten actually did an ultrasound before the surgery to find Rigel’s testicles in his abdomen (instead of having to dig around in there looking for them during the surgery itself). I hung around the area for a few hours during the procedure, waiting for the call that he was ready to go home.

When I finally came to pick him up the veterinarian wanted to talk to me. She said the surgery went well, everything was fine, but they did notice one thing during the operation - he had what they thought was a very big bladder that was also more elongated than a “normal” bladder would be. They thought there may be some blockage or infection so they passed in a catheter to check for both. They drained the urine with a catheter, found no blockage, and no infection. They said the bladder contracted nicely after being drained. So he was good to go! I thanked her and brought Rigel home, excited to have him start his post-op recovery.

Unfortunately on February 14th we noticed that Rigel wasn’t peeing. He kept straining to go to the litter box, but nothing was coming out. We read that after an operation the cat’s urination and pooping habits might be a bit wonky, but this was worrying - he just couldn’t seem to pee.

We took him back to DjurAkuten, where they I think passed in another catheter to drain the urine and again tested for infection. Unlike the test during the surgery, they now found bacteria. They sent him home with antibiotics.

The next day he still did not pee. We rushed him back to DjurAkuten. They said that at this point they should put in a catheter and keep him overnight. However, DjurAkuten do not have staff on-site 24/7 and said they would understand if we wanted to go to a larger hospital who did. They recommended Baker, a big hospital about 5km from our house. We took a taxi there instead.

During the consultation Rigel was trying to pee and got a few drops of bloody urine out. At this point we were starting to put two and two together and the veterinarian diplomatically confirmed - judging by the fact that Rigel was totally fine and had no problems peeing before the surgery, that the first catheter passed in during the surgery found no bacteria and two days later there was suddenly an infection, it seems that DjurAkuten introduced a urinary infection while testing for a urinary infection. We were devastated - here we had a perfectly healthy kitten who went in for a routine surgery, had a catheter stuck in him (unrelated to the actual surgery) because they thought his bladder looked big, and was now in this mess. Thank god…or whoever…we had insurance.

Rigel stayed at Baker for I think two nights with a catheter (though I’d have to check the journal to know for sure). Finally they called us and said he peed on his own and that he can come home! We were ecstatic - our kitten was ok again!

So we took him home. Except he still didn’t pee on his own. And this time he wasn’t even trying. At first I thought maybe that’s a good sign…maybe his bladder just hadn’t filled enough? If he didn’t need to pee that’s good, right?! When he hadn’t peed in 24 hours we took him back again. They drained 400ml of urine. Did they send him home with an already filling bladder?! And now there was talk of atony and distension. This is where “distended bladder” starts showing up in the journal, and nerve damage. It wasn’t good that he didn’t feel the need to pee after all - it was a sign that his bladder was now damaged to the point of him not being able to feel the need to go. The infection may be gone, but now we are on to a whole new problem.

They kept him again. We visited him every day. They put him on new meds and put in a catheter.

A few days later they called us saying he ripped out his catheter, but we should take him home because the new meds seem promising. We take him home. At this point our nerves are shot and we have no idea what’s going on. We just want him to get better.

Rigel has been to the hospital so much now that we have a routine. I bring him in. They take him to an individual waiting room after the main waiting room. I take off my jacket and spread it out on a chair for him. He curls up there and has a nap.

He tries to pee and can’t (but at least he tries now). We rush him back. This is a nightmare. I notice the penis looks a bit swollen and ask someone if it’s possible that there is now a blockage or injury or scarring or SOMETHING there after he ripped out his catheter. They say it looks a little swollen but that’s normal after the catheters. They suspect the problem is the bladder, not the urethra - but then why is he trying to pee? Clearly he can feel his bladder still! We are very confused, but the vets are saying he’s been checked for blockage several times and there has been none. Ok, fine..but he hasn’t been checked since he last ripped out his catheter, right? Baker has also been hoping that letting his bladder get full will encourage him to pee, so they suggested waiting 2, maybe up to 3 days at a time before emptying it. His bladder is naturally big and by this time it was so stretched that it wasn’t going “hard” from fullness in even that time. But it didn’t help. They start talking about putting him to sleep, about us soon running out of options. His insurance is running out, but we reiterate that we don’t care how much it costs - I’ll pay for the treatment without insurance. Rigel was registered to me and Kaytu was officially David’s, so Rigel’s costs were on me. He started off as a perfectly healthy young kitten and now he is going through this mess because someone decided to stick a catheter in him because his bladder looked big.

Baker’s plan is to do a surgery to put in an abdominal catheter and send Rigel home with it for a week, hoping this will give his bladder a chance to rest and recover function. But I’m worried - if there IS some blockage in the urethra now how would an abdominal catheter help? Won’t we just be back at square one? At this point I don’t know who to trust anymore and we are contacting anyone we can who may be able to help. What’s more, little things keep going wrong - he keeps seeing a new vet each time, and none of them seem to know all the details even though they all know his “general” story. On our last visit there a nurse feels his bladder and says it feels small. We get excited! But then the vet checks the bladder and says it’s very large and needs to be drained again. What is going on?! One place keeps coming up from multiple sources - a big university hospital (“UH”) in Uppsala. This is a large univeristy animal hospital that’s meant to be the best.

We hold off on the surgery until Monday, take Rigel home for the weekend, and call the UH small animal hospital in Uppsala. We ask if we can bring Rigel for a second opinion tomorrow and they say yes. It’s two hours away by public transport but a very kind friend of ours takes the time to drive Rigel and me there on a Sunday. He is inspected and stays there, to hopefully see an internal medicine specialist the next day.

We are cautiously optimistic - we’re told this place is the best. If anyone can fix him they can.

He stays there for…I think a week? Two? Time is now blurring together. They put him on new medication, but he is not trying to pee. This is devastating, because just the day before we brought him in he was trying but unable to go and now they say he’s not going at all!

I visit him throughout this time, catching trains to Uppsala after work. The vets are surprised that he still seems to be in such good spirits through all this - all the pills, the procedures. He has to be sedated daily to have his bladder drained with a needle, and yet he’s still active, playing, and “doesn’t even know he’s sick”. One time I visit and the nurse spends 30 minutes explaining to me how serious his situation is, how they are running out of options, and how there may be nothing we can do because the situation is so serious. Thank you very much. We did not know how serious his situation is. We just happened to stumble into what’s meant to be the best animal hospital hours from home for the heck of it. I came home and cried all night, expecting that the next day I’d get a call from the vet saying they were done.

But the next day I do get a call, and they decide to do a bladder biopsy - surgery #2 after neutering. At the same time they check for blockage by trying to pass a catheter in from the bladder out - no go. Then from the bladder in - very difficult. And finally from the bladder out again. This indicates a potential stricture. I wonder how long it’s been there?! Maybe all that time he’s been trying and unable to pee at Baker he’s actually had a stricture?

The biopsy results themselves apparently don’t show any very useful information, but after finding the stricture (and after he rips out yet another catheter), and after my potentially dumb insistence that we can’t give up now, they decide to do a Perineal Urethrostomy. Rigel has been through a lot and I didn’t want him to suffer by putting him through more procedures that he could handle, but the vets themselves in their daily updates have said that he remains a happy and active cat who is not suffering. The Perineal Urethrostomy is a big surgery that basically amputates part of the penis to remove the thinnest point with the stricture, making the genitals look more like that of a female cat. They don’t know if this will save him - they just know it may alleviate ONE of the problems. The other is his atonic and distended bladder.

It doesn’t seem to help. He yet again rips out a catheter. They wait for a few days, giving him a few hours to feel the need to pee between catheter drainings, but he just does not go. Finally they say that it’s time. They say there is nothing more they can try - the meds just don’t seem to be working, and neither did the surgery. At this point David is in Japan for work and I’m alone at home (well, not alone - our other kitten is there). I ask if it’s ok for them to drain Rigel’s bladder one last time that night so that I can come pick him up and have him spend his last day at home with his family. They say yes, but only under the condition that if he doesn’t try to pee within 24 hours he be put to sleep. I know he can go longer - Baker had waited for days at a time, but they are insistent.

At this point I have a week off of work. I had originally booked it to go away with David, but now of course I’m not going anywhere. I make arrangements and set an appointment with a veterinarian to come to our house and put him to sleep at 4:30pm on Thursday, March 12. As a last ditch effort, desperate, I look for any other veterinarians who might be able to help. Plenty of people live with handicapped pets who can’t pee on their own - they can express their bladder manually 3 times a day and the pets live happy and long lives, and sometimes bladder function even recovers. But nobody’s been able to express Rigel even after the stricture was removed and I find it difficult to understand why.

I find the website of a holistic vet Wednesday morning and email her out of desperation. It just so happens that she lives near the UH hospital and is kind enough to invite us to her house on our way home. I hate the thought of dragging him elsewhere on his last night, but it’s close and I can’t give up now. We go there. He likes her, but he is so tired and uncomfortable after all of the procedures he’s been through. The holistic vet performs acupuncture, which Rigel tolerates well at the time. We go home.

I think about how his last trip with me is on same kind of train that we took when I was bringing him home, just going from the opposite direction, in exactly the same carrier.

On the train we sit next to a kind lady who asks me questions about him and asks if she can pet him in the carrier. I say yes and she reaches in. She ends up getting off at our stop and saying that she “did some healing”. I thank her - he can use all the healing he can get. I explain to her that I’m bringing him home for his last day and she says “We’ll see what happens. It’s up to him now. Just take that cone off when you get home.”

The giant cone on his head is there so that he doesn’t lick his urethrostomy stitches and he hates it. When we get home I take it off and watch him like a hawk to stop him from licking. I spend all night awake, watching him and trying to accept that our kitten is going to die in less than 24 hours and at the same time hoping that some miracle might happen even though the vets say it can’t. Rigel is exhausted. I’m a nervous wreck. The kittens and I are locked in the bedroom with a litter box, toys, and water. I keep us all in the room so that I can stay awake and watch to make sure he’s not licking. He doesn’t mind - he’s not in the mood to play or roam anyway.

Rigel is exhausted. He tries to play with our other kitten, Kaytu, but tires quickly and sleeps.

The next morning he got up to drink some water. Then he started pacing. He’d grumble, pace, grumble, pace, lie down, eye the litter box, pace. I gently scruffed him with one hand and felt for the bladder with the other. I’m not sure if I was feeling the right spot, but I thought I felt it there, full and balloony. Shaking, I gently carried him to the litter box and dug my hand in the litter in front of him. I stepped away and waited. He sniffed around, circled slowly a few times, dug weakly, crouched, and PEED! He peed! By himself! For the first time in over a month!

I tried to get a non-blurry photo but was shaking so much it was impossible.

I was on the phone to UH immediately. I waited and waited and then excitedly told the receptionist that Rigel just peed and that I had to speak to one of the veterinarians who had treated him immediately. They told me to call them straight away if he even so much as tried to get any urine out. I wanted to make sure they knew he peed, and ask what to do next. We were only given a few days of medication and no post-urethrostomy-care instructions, I guess because they thought he wouldn’t need them. But here he was peeing, so maybe he still stood a chance!

I was told someone would call me back as soon as possible. No one called back. In the meantime I contacted the holistic vet, who was very helpful and also got a hold of relevant people at UH to let them know. They had threatened to call “the authorities” if they didn’t hear from me that he tried to pee OR from the vet who’d be putting him to sleep that it was done, so it was important for them to know.

That night I took him to Baker (which is less than 5km away) to check his bladder and make sure it wasn’t too full. They did a ultrasound and confirmed that the bladder was large, but for him at this point it may be a “normal” large. It wasn’t bursting and was still “wavy” instead of “hard”. I was told that if he goes once a day that is good enough. They represcribed some of his medication and said at this point all we can do is wait and see what happens because if he stops peeing there’s not really much they can do anyway, since they’ve already tried everything else. It was terrifying.

The next day I thought I’d made a terrible mistake. I felt Rigel’s bladder in the morning - sometimes he peed right after I palpated it gently, so I did and then picked him up to carry him to the litter box. He started convulsing in my arms. I put him down, terrified that his bladder had ruptured and he was dying. I was on the phone with the taxi, calling to take us to Baker to put him to sleep because I thought he was dying in pain in the house. I was afraid it would be too late. But then he vomited what smelled like the food we were given at Baker for me to give him with his medicine the previous night (the next dose was due while we were there, so they gave me a packet of Hills food to give him with it). Maybe the new food just didn’t agree with him…anyway, after vomiting he seemed better. I put him in the box gently and he peed again, then demanded food.

I again called UH, again to no response. I thought they’d be happy that he started peeing, but they seemed to want nothing to do with Rigel anymore. I’m not sure why…I wanted to thank them for everything they’ve done for him, for the surgery, etc, but I still haven’t heard back from them since.

And so it went on. As soon as it started to get dark I’d start counting the hours. It was the worst week of my life but I know it would have been a million times worse for Rigel himself. Sometimes Rigel would pee twice a day, and then suddenly he didn’t pee for 25 hours. It fluctuated wildly. The holistic vet came and looked at him last Sunday - she said he looked much better than when she first saw him and said that his bladder felt good.

We spent the days in the sunniest rooms, where the cats preferred to be. I’d spread out some blankets on the floor and watch him, and take quick naps when he did. We were both so tired.

Last Monday we had an appointment back at Baker to bring him in and see how to proceed. After all, we had no idea what the heck happened. His meds were running out within days and I had no idea where to go from here. We managed to get an appointment with the internal medicine specialist at Baker - the first time we’ve actually met one of these specialists in person. She was very nice, looked through his gigantic journal history, and represecribed the medications. She explained what she thought had happened, and also that the bladder, like any other organ, can be a highly individual thing. Just because it may look more elongated or larger than normal doesn’t mean you necessarily have to start poking around in there if no problems had been reported. They took a blood test and instructed me to get a urine sample to test for organ failure, infection, etc. She said he looked like a…normal cat. By that point he seems to have rested from the long and stressful hospital stay and was feeling more himself, playing, exploring.

At this point I’d been running on maybe 7 hours of sleep since the previous Wednesday and feeling loopy. I was dragging Rigel’s pee clumps around to the vet in case they were relevant, hadn’t had a hot meal in days, and all of my pants were now falling off of me. That afternoon the vet called with blood test results - kidneys were functioning well, he had slight anemia (she said normal after surgery) and potentially a sign of either some mild allergy OR a parasite. She said normally in this case they’d deworm the cat, but he’s already balancing so many medications that they didn’t want to risk it just then.

She also said to take him off of one of the meds - Stesolid (Valium). I was scared to make it worse, but I know he can’t be on these high dosages and medications forever, so we stopped with the Stesolid.

I managed to get a urine sample by holding a measuring cup under him a couple of mornings later. I brought it in to the hospital at about 5am. The specialist called us the next day saying there was no obvious sign of infection, the urine concentration and pH level looked good, and the one slightly concerning thing she saw was some bladder cells coming out in the urine. She says that also may be normal after surgery, but I need to submit another urine sample this upcoming Monday to recheck.

David also got home from his work trip Tuesday night, and made me my first warm meal in a week. He’s been helping to watch him while I’ve had to go back to work since.

The holistic vet looked through his UH journals and confirmed that the stitches they used for the urethrostomy were non-dissolving and need to be taken out in 10 days. That was day 10, so I made an appointment to have them looked at and potentially removed the next day (yesterday). It was much rougher than I thought! The vet just ripped off his scab down there with her hand - it started bleeding. Then bled some more while they were cutting the stitches around his urethral opening. I had read that one serious potential complication of the urethrostomy is tissue healing over the opening, creating yet another obstruction, and I was worried that continued damage to the area like this could make this worse! We were told he’d have to not lick that area for another 7 days at least until it healed, and even afterwards we’d have to watch him to make sure he’s not obsessively licking there (but he’s never been an obsessive licker, at least not until now). Rigel was so good throughout, though. I had to help hold him in the front while the nurse removed the stitches. He just wrapped a foreleg around my arm, buried his face in my sweater, and cried. The area there is tender now, but he’s peed twice since he got back…we are watching like hawks for any signs of him straining or having other trouble.

Rigel has become adept at removing his cone by himself. I ended up getting a harness from a pet store and tying the bandage-tie around his neck to that, so that he can’t pull it over his head.

When I come home now he bolts down the stairs to meet me - he used to meet me at the top of the stairs, but now he trots down to the door and looks up at me for scratches. It’s always so nice to see him.

I’m still so scared of something going wrong - bladder getting worse, stricture post-surgery, something. Nobody knows what’s going to happen. It’s been just over a week since the day he was meant to be put to sleep and he seems to be feeling much better and acting very playful and affectionate. He is still having some constipation but we’re managing that. But I’m afraid of getting too confident - things can go downhill at any time, and so many things have already gone wrong. But at least he’s still here now - still happy, relaxed, and (please knock all the wood in your house for this one) still peeing.