Friday, February 4, 2011

Prozac and Urine Retention and When Not to Trust a Vet

An update on the cat on Prozac:

I know I said that this would be a blog about Myrna, our HCM cat. But I can't help noting important items about our other cats as well. 

Jimmy, as I've mentioned before, is on Prozac for spraying/marking after trying amitriptyline and while his behavior improved radically, with no doped up effects such as with amitriptyline, it did however cause severe urine retention.  Urine retention is the inability of the bladder to fully empty but in his case, it involved the bladder not being able to signal it was full until after he'd been holding it in for 12-18 hours. At first, Jimmy was going every 12 hours which worried me. But then he began going 15 hours and then this last week, 18 hours. Meanwhile, he was drinking water and sleeping his normal amount. But after a few hours, he was noticeably uncomfortable.  Last week, I began to give him 12-15 ccs of water and bladder rubs after 12 hours to help stimulate his bladder. This would make him go in the next hour. 

But here's the kicker-there is no on-line information regarding urine retention in cats other than a note that slight urine retention with amitriptyline or Prozac may occur. There is no on-line information regarding how severe this could become and what could possibly be the results except in cases where there is a disease, an infection, or physical damage. There is one study that showed urine retention with Clomincalm, a tricyclic like amitriptyline in one patient which was resolved when the cat was taken off of the meds, given sub q fluids, and hospitalized for a week until normal bladder elimination was achieved.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539679/pdf/canvetj00137-0059.pdf

But neither his regular vet nor another vet we consulted had ever heard of urine retention in a cat with Prozac.  The consulting vet said that since it was possibly caused by medication, that decreasing the Prozac might restore normal bladder function. His regular vet, however, disagreed with my findings-both the on-line report and my insights to my cat's behavior. That we had him on a bathroom schedule prior to any meds was unusual she said and therefore perhaps he had had an infection which is why he urinated 3 or more times a day. She said it was perfectly normal for him to go every 12 hours. Well, we had him tested twice during that time prior to meds and no UTI or other infection was found by her. She said if he's not going it's because he doesn't like the box, the litter, or the placement of the box.  But we've been through all of this before and everything was working fine prior to putting him on any meds. She then said that he wasn't drinking enough water and that I just assumed he needed to go when he really didn't need to go. Except when I felt his bladder region, I could tell that it was extremely full not to mention that I saw him drink plenty of water during the day and had given him a few cc's of water by mouth.  She said that perhaps he had an infection or a blockage except he was tested last week by the consulting doctor and no, he did not have either. He's been able to go such large amounts that I referred to them as lakes when normally he would go ponds. Not to mention that after his urine was withdrawn and tested for a UTI at the consulting vet's, he urinated a lake on their floor.

 We are concerned for his bladder health so we've decided to take drastic measures into our own hands.. A bladder that remains full can create UTIs and other health related issues to the bladder and to the kidneys. A male's urethra can become blocked requiring surgery. The bladder could become stretched and weak and urine leakage could occur or lead to further inappropriate elimination issues if he couldn't hold it in before making it to the box. We want to restore normal bladder function before reinstating Prozac. We've withdrawn the Prozac for now and we are not weaning him off from it. He was only on it for a month so we doubt it will be too much of a shock or so we hope. We will give him a slight amount of amitriptyline if he gets overly anxious.  If we do begin Prozac again, we have a compounded formula in a liquid form to try to adjust the dose between what would have been 1/8 to a 1/4 of a tab (and tabs are difficult to cut precisely.)  We are monitoring his actions and reactions.  We are spending time with him and engaging him and taking him on bathroom breaks-all which we were doing while he was on either of the meds. If spraying/marking begins, we will clean and watch and adjust. We are more concerned with his health at this time. I will continue to give 3 ccs of water with each meal and maybe more in the evening if it seems that he has not gone much during the day.

As for the vet, the consulting vet was an hour away, too far to go on a regular basis but his regular vet lacks experience and knowledge. We'll have to find a new vet if possible, preferably one who listens and understands that owners often have more insight into their cat's normal vs. sick behavior than what doctors have learned in vet school. As human patients go, animals are not always as straight forward as the text book cases one learns in vet school.

All I want is my little boy back, the one who played with toys, was happy and engaged, and used the litter box and wasn't afraid of anything.

Jimmy at 10 weeks

3 comments:

  1. Thank you for your Post. I know its a few years past your original Post and I hope Jimmy is good. I've just returned from Afghanistan and adopted a cat. Understandably its been an enormous change and just last week I and the vet decided to put him on a small amount of Prozac every other day.But he's not urinating and I'm scared and worried. You were the 1st to make this connection and to acknowledge there there's not much on the net to help

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  2. Don't give up on the Prozac. It's been better for our Jimmy than the amitriptyline he first tried. But yes, we couldn't adjust Prozac in pill form because of the way it's shaped. We have it compounded and I can make adjustments as necessary. I'd start with a lower dose and work your way up from there. When you see him able to go for a few days then slowly work your way up. We took about a year starting at .120 down to .1 then back up again. Good luck!

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  3. Compounded-into liquid form.

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