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Mike S.
October 23rd 05, 07:26 AM
The vet told me that my cat has a calcium oxalate stone but that it's
located in a place where they cannot perform surgery. They're just
gonna have to wait and see what happens with it and keep an eye on it.
I can't remember the location of the stone but I think it was above or
around the colon. Does anyone happen to know what/where it might be? I
was going to do some research on it but the vet isn't open on Sunday so
I can't ask. I think the location started with the letter U, but I'm
not sure. I don't think it was in the urethra or the bladder, though.

Any ideas?

No More Retail
October 23rd 05, 07:30 AM
http://www.veterinarypartner.com/Content.plx?P=A&A=1741

Phil P.
October 23rd 05, 05:23 PM
"Mike S." > wrote in message
oups.com...
> The vet told me that my cat has a calcium oxalate stone but that it's
> located in a place where they cannot perform surgery. They're just
> gonna have to wait and see what happens with it and keep an eye on it.
> I can't remember the location of the stone but I think it was above or
> around the colon. Does anyone happen to know what/where it might be? I
> was going to do some research on it but the vet isn't open on Sunday so
> I can't ask. I think the location started with the letter U, but I'm
> not sure. I don't think it was in the urethra or the bladder, though.
>
> Any ideas?


If the stone is near the colon, it has to be in the lower end of the one of
the ureters. The colon sits between the two ureters at their lower ends
just before they enter the bladder. Very tricky spot- right near where the
ureters go around the colon, they also go under the ductus deferens. Where
the ureter and ductus deferens cross kinda looks like the number 6 or the
bottom of a figure 8. The stone is probably lodged in the ureter where it
curves to go under the ductus deferens and into the bladder. If you look at
this drawing, the spot I'm talking about is just a little to the left of the
red number 8.

http://www.maxshouse.com/anatomy/upper_urinary_tract_male.jpg


Here's an overview of the male cat's urogenital system so you can follow the
urine from the kidneys:

http://www.maxshouse.com/anatomy/anatomy_urogenital_sys.jpg

If the ureterolith doesn't pass and must be removed, you'll need a surgeon
with exacting skill and keen surgical vision. This surgery is much too
delicate for a general veterinary practioner- that's why your vet said the
stone can't be removed. But a surgical Diplomate of the American College of
Veterinary Surgeons could probably take it out without breaking a sweat.

Go to:

http://www.acvs.org/AnimalOwners/DiplomateDirectory/

to locate a ACVS surgeon in your area. Then ask your vet to send him the
x-rays or ultrasound printout for his expert opinion.

Years ago, only 2 or 3% of all the stones found in feline urinary tracts
were calcium oxalate- most stones were struvite (which can be dissolved).
Since the pet food companies decided to reduce the magnesium and increase
the acidity of feline diets to prevent struvite, now >42% of the all the
stones found in cats are calcium oxalate. By solving one problem, the pet
food companies created a worse problem. At least struvite can be dissolved
medically- calcium oxalate can't.

Best of luck,

Phil

No More Retail
October 23rd 05, 05:37 PM
Hey Phil I know that they have a well not so new ultra sound surgery
procedure that breaks the stone up with sound wave for humans I wonder if
they are using this on animals I know for humans it is a no cut procedure

Mike S.
October 24th 05, 07:02 AM
Phil P. wrote:
> "Mike S." > wrote in message
> oups.com...
> > The vet told me that my cat has a calcium oxalate stone but that it's
> > located in a place where they cannot perform surgery. They're just
> > gonna have to wait and see what happens with it and keep an eye on it.
> > I can't remember the location of the stone but I think it was above or
> > around the colon. Does anyone happen to know what/where it might be? I
> > was going to do some research on it but the vet isn't open on Sunday so
> > I can't ask. I think the location started with the letter U, but I'm
> > not sure. I don't think it was in the urethra or the bladder, though.
> >
> > Any ideas?
>
>
> If the stone is near the colon, it has to be in the lower end of the one of
> the ureters. The colon sits between the two ureters at their lower ends
> just before they enter the bladder. Very tricky spot- right near where the
> ureters go around the colon, they also go under the ductus deferens. Where
> the ureter and ductus deferens cross kinda looks like the number 6 or the
> bottom of a figure 8. The stone is probably lodged in the ureter where it
> curves to go under the ductus deferens and into the bladder. If you look at
> this drawing, the spot I'm talking about is just a little to the left of the
> red number 8.
>
> http://www.maxshouse.com/anatomy/upper_urinary_tract_male.jpg
>
> If the ureterolith doesn't pass and must be removed, you'll need a surgeon
> with exacting skill and keen surgical vision. This surgery is much too
> delicate for a general veterinary practioner- that's why your vet said the
> stone can't be removed. But a surgical Diplomate of the American College of
> Veterinary Surgeons could probably take it out without breaking a sweat.
>
>
> Phil


Yes, the stone is in one of the ureters, I remembered after seeing the
diagrams. The vet said that even if the cat was sent to a specialist,
they wouldn't perform the surgery. I can't remember the exact reason
but it seems like part of it was because the ureter wouldn't heal
properly (I can't remember). Right now, we have a series of problems
though. The cat has the stone in the ureter, something that appears as
a megacolon, and kidney problems. This is the second time he's had a
calcium stone.

I tried searching for info about surgery to remove a stone from the
ureter and I can't seem to find anything that goes with what the vet is
saying. I guess I should say something to him about that and see if he
could ask the specialist about it. To be honest, it sounds like he's
wrong about this.

Then I have a problem with the specialist. There's only one practice in
my area (the rest are one and a half to two hours away) and there's
only two doctors there. The one doctor who is the only ACVS Diplomate
at that practice, screwed up on a procedure years ago. I hate to
discriminate against a doctor for what may have started out as a simple
mistake/accident but in my opinion, that was a big mistake. The doctor
bandaged an animal's leg too tight after surgery and the end result was
that the leg had to be amputated. If he had made this mistake shortly
after getting his license, that would be a little different but he had
been practicing for years when he did this. It makes me concerned about
letting him cut my cat open. That combined with his age, makes me even
more concerned.

Phil P.
October 25th 05, 06:17 AM
"Mike S." > wrote in message
oups.com...
>
> Phil P. wrote:
> > "Mike S." > wrote in message
> > oups.com...
> > > The vet told me that my cat has a calcium oxalate stone but that it's
> > > located in a place where they cannot perform surgery. They're just
> > > gonna have to wait and see what happens with it and keep an eye on it.
> > > I can't remember the location of the stone but I think it was above or
> > > around the colon. Does anyone happen to know what/where it might be? I
> > > was going to do some research on it but the vet isn't open on Sunday
so
> > > I can't ask. I think the location started with the letter U, but I'm
> > > not sure. I don't think it was in the urethra or the bladder, though.
> > >
> > > Any ideas?
> >
> >
> > If the stone is near the colon, it has to be in the lower end of the one
of
> > the ureters. The colon sits between the two ureters at their lower ends
> > just before they enter the bladder. Very tricky spot- right near where
the
> > ureters go around the colon, they also go under the ductus deferens.
Where
> > the ureter and ductus deferens cross kinda looks like the number 6 or
the
> > bottom of a figure 8. The stone is probably lodged in the ureter where
it
> > curves to go under the ductus deferens and into the bladder. If you
look at
> > this drawing, the spot I'm talking about is just a little to the left of
the
> > red number 8.
> >
> > http://www.maxshouse.com/anatomy/upper_urinary_tract_male.jpg
> >
> > If the ureterolith doesn't pass and must be removed, you'll need a
surgeon
> > with exacting skill and keen surgical vision. This surgery is much too
> > delicate for a general veterinary practioner- that's why your vet said
the
> > stone can't be removed. But a surgical Diplomate of the American
College of
> > Veterinary Surgeons could probably take it out without breaking a sweat.
> >
> >
> > Phil
>
>
> Yes, the stone is in one of the ureters, I remembered after seeing the
> diagrams. The vet said that even if the cat was sent to a specialist,
> they wouldn't perform the surgery.


Your vet is misinformed. Ureterotomies are the only way to remove
ureteroliths in cats and have been performed for many years. Its not a
simple surgery and should be a last resort- there is a risk of postoperative
leakage and stricture formation- so it must be performed very carefully- but
it can and has been done.


I can't remember the exact reason
> but it seems like part of it was because the ureter wouldn't heal
> properly (I can't remember).


He was probably thinking about ureteral anastomois- that's when a section of
the ureter is removed and the cut ends are joined together. That's a very
difficult surgery to perform in cats. But that's not the type of procedure
your needs- if he needs surgery.



Right now, we have a series of problems
> though. The cat has the stone in the ureter, something that appears as
> a megacolon, and kidney problems. This is the second time he's had a
> calcium stone.

The kidney problem could be caused by the ureterolith- If the ureter (or
urethra) is partially obstructed, urine backs up into the kidney producing a
pathophysiologic state equivalent to oliguric acute renal failure (elevated
BUN/Creatinine).


>
> I tried searching for info about surgery to remove a stone from the
> ureter and I can't seem to find anything that goes with what the vet is
> saying.

That's because he's wrong and/or misinformed/uniformed. Here's a simplified
illustration of the procedure

http://www.maxshouse.com/Illustrations/Ureterotomy.jpg


I guess I should say something to him about that and see if he
> could ask the specialist about it. To be honest, it sounds like he's
> wrong about this.

He is. Some vets just can't say "I don't know" or "I don't know how to
perform that type of surgery".


>
> Then I have a problem with the specialist. There's only one practice in
> my area (the rest are one and a half to two hours away) and there's
> only two doctors there. The one doctor who is the only ACVS Diplomate
> at that practice, screwed up on a procedure years ago. I hate to
> discriminate against a doctor for what may have started out as a simple
> mistake/accident but in my opinion, that was a big mistake. The doctor
> bandaged an animal's leg too tight after surgery and the end result was
> that the leg had to be amputated. If he had made this mistake shortly
> after getting his license, that would be a little different but he had
> been practicing for years when he did this. It makes me concerned about
> letting him cut my cat open. That combined with his age, makes me even
> more concerned.


Do you live within travelling distance of a veterinary university hospital?
Or perhaps you can call and ask them for a referral.

Is you cat urinating normally? Gotta watch him *very* closely. If a male
cat can't urinate for more than 24-36 hours he can die from anuric acute
failure

Best of luck,

Phil

Mike S.
October 26th 05, 06:02 AM
> Your vet is misinformed. Ureterotomies are the only way to remove
> ureteroliths in cats and have been performed for many years. Its not a
> simple surgery and should be a last resort- there is a risk of postoperative
> leakage and stricture formation- so it must be performed very carefully- but
> it can and has been done.
>
>
> >I can't remember the exact reason
> > but it seems like part of it was because the ureter wouldn't heal
> > properly (I can't remember).
>
>
> He was probably thinking about ureteral anastomois- that's when a section of
> the ureter is removed and the cut ends are joined together. That's a very
> difficult surgery to perform in cats. But that's not the type of procedure
> your needs- if he needs surgery.
>
>


How (or at what point) do I know if and when he needs surgery to remove
the stone? I was under the impression that all calcium oxalate stones
have to be surgically removed. Will the stone move from the ureter and
into the bladder? The vet acted like it wouldn't move and would stay in
the ureter. He thoroughly confused me because he gave me the runaround
when I asked about how to remove it.

No More Retail
October 26th 05, 03:38 PM
Mike you need to find another vet if the vet has confused you and you took
it into your part to question him or her about it and they gave you the run
around leave that vet below is a link about the stones
there are factors to consider if surgery is necessary or a change in diet
will help
http://www.marvistavet.com/html/bladder_stones.html

Phil P.
October 26th 05, 05:14 PM
"Mike S." > wrote in message
oups.com...

> How (or at what point) do I know if and when he needs surgery to remove
> the stone?

I don't want to alarm you- but a ureterolith can cause an obstruction of
urine flow that can result in anuric acute renal failure and death if the
obstruction isn't removed in ~24 hours. A partial obstruction of a ureter
results in decreased renal blood flow, reduced glomerular filtration rate-
and eventually irreversible damage to the kidney. Usually, the time between
diagnosis and surgery is 2-4 days.

The sign that it needs to be removed would be the inability to urinate due
to an obstruction- which is a true urologic emergency. However, the physical
condition that he'd be in would make him a poor anesthetic and surgical
candidate.

Some vets recommend placing the cat on a calcium oxalate diet (Hill's
Prescription Diet x/d) to hopefully prevent the ureterolith from become any
larger- but this is very risky because the stone can cause an obstruction at
any time- e.g., late at night, on a weekend or while you're at work.



I was under the impression that all calcium oxalate stones
> have to be surgically removed. Will the stone move from the ureter and
> into the bladder?

Yes- but only in about 1 out of 3 cats. CalOx ureteroliths are usually
embedded in the wall of the ureter- that's why they usually must be removed
surgically. There is some anecdotal evidence that glucagon (0.1 mg/cat bid
S/C) might relax ureteral smooth muscle which might help the stone pass into
the bladder. There are no controlled studies and we've haven't tried it,
so, I can't make any recommendations.



The vet acted like it wouldn't move and would stay in
> the ureter.

I didn't see the x-ray or sonogram so I don't know how big it is or its
exact location- but most ureteroliths are embedded in the ureter and don't
budge. Your cat obviously isn't obstructed (yet) so, a CalOx diet might
prevent the stone from getting any larger- but there's no guarantee and its
a very high risk and dangerous strategy because the cat can block at any
time.


He thoroughly confused me because he gave me the runaround
> when I asked about how to remove it.

That's probably because he not well informed and/or he doesn't have any
experience in ureteral surgery. When a vet knows what he's talking about
they usually explain each option very clearly and make sure you understand.

I've been very hesitant to mention shock-wave lithotripsy (actually
""extracorporeal shock-wave lithotripsy" (ESWL) because its only successful
in about 50% of the cases in small animals. The procedure is noninvasive
but still carries anesthetic and post-procedure risks- albeit less than
surgery. The cost is about the same as surgery. The problem is- if ESWL is
unsuccessful, can you or would you afford surgery? If you can afford both-
then, I would try ESWL first- you might get lucky. But if you can't afford
both, then, I would opt for surgery because it has better odds of being
successful-- ~91%.

Lithotripsy isn't available everywhere- usually only in veterinary
university hospitals or top shelf vet hospitals such as the Animal Medical
Center in NYC. If you would like more information on feline ureteral
surgery, let me know.

Best of luck,

Phil

Mike S.
October 28th 05, 08:50 AM
I spoke to the vet as well as the internal medicine specialist
yesterday and they all said that they don't/can't remove ureter calculi
in cats. They said that they would in dogs but not in cats. I told them
that I read that the surgery is possible but they're all saying no.

They're going to call around to see if anyone will perform the surgery
but they don't think anyone in the state will.

At this point, I don't know who to believe or what to do. From what
I've read, even if someone was able to perform the surgery, it's very
risky. There was something about the kidneys and some sort of leakage
problem.

Does anyone have any suggestions or advice as to what I should do? I
can't afford to travel to another state to have this surgery done, if
someone would do it. They won't even do any of the other treatment
options such as that shock wave/ultrasound thing.

IBen Getiner
October 28th 05, 09:21 AM
Mike S. wrote:
> The vet told me that my cat has a calcium oxalate stone but that it's
> located in a place where they cannot perform surgery. They're just
> gonna have to wait and see what happens with it and keep an eye on it.
> I can't remember the location of the stone but I think it was above or
> around the colon. Does anyone happen to know what/where it might be? I
> was going to do some research on it but the vet isn't open on Sunday so
> I can't ask. I think the location started with the letter U, but I'm
> not sure. I don't think it was in the urethra or the bladder, though.
>
> Any ideas?

No.. Any more questions...?


IbEn

Phil P.
October 28th 05, 09:49 AM
"Mike S." > wrote in message
ups.com...
> I spoke to the vet as well as the internal medicine specialist
> yesterday and they all said that they don't/can't remove ureter calculi
> in cats. They said that they would in dogs but not in cats. I told them
> that I read that the surgery is possible but they're all saying no.

Some vets just can't say "I don't know" or "I'm not skilled enough to
perform that surgery". They rather see a cat die than bruise their fragile
egos.

Print these articles out and staple them to your vet and internal medicine
specialist's foreheads:

http://www.maxshouse.com/urology/feline_ureteral_surgery.htm

http://www.maxshouse.com/urology/management_of_nephroliths_and_ur.htm


>
> They're going to call around to see if anyone will perform the surgery
> but they don't think anyone in the state will.
>
> At this point, I don't know who to believe or what to do. From what
> I've read, even if someone was able to perform the surgery, it's very
> risky. There was something about the kidneys and some sort of leakage
> problem.
>
> Does anyone have any suggestions or advice as to what I should do? I
> can't afford to travel to another state to have this surgery done, if
> someone would do it. They won't even do any of the other treatment
> options such as that shock wave/ultrasound thing.


Try calling Dr. Salisbury at Purdue University, West Lafayette, Indiana
and Dr. Andrew E. Kyles at the University of California- Davis. Both of
the drs. perform the surgery- maybe they can refer you to a surgeon who
can help you.

Where do you live? I'll try to help you find a surgeon.

Keep the faith.

Phil