Need advice for chronic UTI

Hi all,

My male cat is 10 months old and has suffered recurring urinary tract infections since he was about 2 months old. Initially, he had recurring infections about every six weeks, and the vet said that since he was a stray, his background might have contributed to the first couple of infections.

By the time he was four months old, the vet was wanting me to put him on a special diet...Hills c/d (with every infection, struvite crystals were found). The cat despised the food, and I ended up putting him on a raw food diet for nine weeks. He exceled on the diet (was extremely healthy, shiny hair, good appetite), but 9 weeks after starting the food, he got another infection (this was his longest period without an infection). Took him back to the vet, and after antibiotics, the cat was again put on a special diet--this time, Royal Canin S/O.

A week after starting the Royal Canin, he was peeing blood again, and after a trip to the emergency room, I was told he had a severe urinary tract infection (this was one week after finishing the last round of antibiotics). I changed vets at this point, and the new vet put him on six weeks of antibiotics (and probiotics at the same time to keep his good bacteria alive), two weeks after finishing the antibiotics, he had a urinanalysis, which showed the infection was totally gone, and his pH balance was 6.5. I took him back four weeks later (six weeks after finishing the antibiotics), and his pH was still 6.5 with no crystals and no blood in the urine.

Now, we are eight weeks since the last urinanalysis was clear (12 weeks since the last antibiotics), and we have another infection. He has been strictly on Royal Canin this whole time. The vet is now asking for a ultrasound to be done (at the price of about $300) to see if he has stones...and I'll add right here that they did an x-ray that didn't show anything in his kidneys or bladder and all blood tests have come back normal.

Now this is where I need advice and experience. I have several questions I'm hoping you all can help with:

1) If his pH is staying 6.5 (which I was told is neutral for cats), then why is he still developing crystals?

2) The bag of Royal Canin S/O says that it dissolves struvite stones...so given that he's been on this food (wet and dry) for 12 weeks, how likely is it that he's still got stones (if he had some that didn't show up in the x-ray)? How long should it take to dissolve stones?

3) And if he doesn't have stones, but is developing crystals while on Royal Canin, what do you guys recommend to help him? And why would he still develop stones?

I know that I need the vets opinion on this, but I wanted some feedback before I get the scan done in the next week or so. My vet is knowledgble, but hardly an expert in this field, and most of the questions I'm asking (like the ones above), she tells me she just doesn't know the answers.

I'm feeling very VERY frustrated right now. My baby is sick, and what I'm doing doesn't seem to be helping. And from what the vet said, I'm looking at hundreds of dollars for scans and surgeries...and to be honest, this is a little expensive for my budget. So I need a direct course of action that will eliminate unnecessary tests and procedures while giving me and my kitty the best possible results.

And thanks in advance for any help or advice you can offer.

Has a full blood panel been done???

To be honest, I'm not sure.

The vet ran several blood tests, all of which came back normal. But she never actually mentioned the names of the blood tests. I'll call her tomorrow to find out.

1) If his pH is staying 6.5 (which I was told is neutral for cats), then why is he still developing crystals?

I'm not sure. Based on the info I've read, 6.5 should be fine..the upper end of fine, but fine. In Beandip's case, it wasn't. He had crystals and infections w/ a pH of 6.5, ongoing for a year and a half.

2) The bag of Royal Canin S/O says that it dissolves struvite stones...so given that he's been on this food (wet and dry) for 12 weeks, how likely is it that he's still got stones (if he had some that didn't show up in the x-ray)? How long should it take to dissolve stones?

IMO, it's very likely he still has struvite stones. Your boy's history and test results are eerily similar to Beandip's. In Beandip's case, the dry Rx food never worked. I will say that I've heard that it was the solution for many cats, but not mine.

3) And if he doesn't have stones, but is developing crystals while on Royal Canin, what do you guys recommend to help him? And why would he still develop stones?

My Beandip was on the Hills prescription dry urinary food (c/d) for a year and a half, but still had "episodes" (infections, etc) about every 6 weeks throughout that whole time.

I tried getting him on the wet c/d, he wouldn't eat it.

I tried putting him on a commercial raw diet (Nature's Variety) and he did better, but 2 weeks later was having some trouble. He had a U/A, and the results were interesting. His pH was up (7.0), where it had been 6.5 on the c/d. BUT, he had no crystals, bacteria, nor blood in his urine that time. So that was progress, but he still needed "something". So I talked to the vet and put him on an acidifier (L-methionine) along with the Nature's Variety. He did much better. Two weeks after starting the acidifier, he was a brand new cat. His attitude, demeanor, activity level - everything was magically better. I'm not kidding. I kept him on the methionine, along with the NV food. He still had occasional "blips"...just exhibiting the little behaviors that tell me he was having an "off" day. Nothing severe enough for a vet trip, just minor things. It's hard to explain. So I switched him to a simpler raw with no veggies, fruits, or anything optional in it. Much better! He's been trouble free for months. I no longer have to spend my days and nights wondering if he peed yet or not, and how much. What a long battle, I do feel your pain. You and your boy deserve a hug.

I still give him Methionine, but I use the tablets from Drs. Foster and Smith. He eats them like candy, so that makes it easy. I need to get a sample from him some day soon, as I don't honestly know what his pH is now. I suspect it's close to 6.0. He never had a good day at 6.5. It is a good idea to monitor the pH when they're on the acidifiers, as you don't want the pH going too low.

I hope the info is helpful. I know how frustrating it can be. Hopefully you and the vet can come up with a good solution for him.

just wanted to say I feel for you. I just went through about 6 months of UTI issues with on eo fmy cats, buteverything seems to be all cleared up now. He had PU surgery done in April, which seems to have worked. If he's been on the r/x food this whole time, I don't think he wouldhave any crystals, maybe just and infection.

It sounds kinda to me like he has had infections that have never cleared up. What has the vet tried for antibiotics? Usually they try clavamox but perhaps baytril for two weeks or so might help. Sometimes the infection is caused by a more persistant kind of bacteria that isn't affected by the clavamox and/or he wasn't on them long enough.
Pippin's had recurring UTIs since his PU surgery. He had both kinds of crystals before the surgery and UTIs caused by the irritation. We tried all the different prescription foods but he is hellaciously picky.
I moved him to Nutro Max Cat Roasted Chicken which is reccommended for UTI kitties specifically. He also has a water fountain and is on two meals of premium wet food (Wellness Canned Grain Free varieties) and that has helped balance his PH levels and cleared up the crystals.
He still has lingering problems with UTIs but that's not out of the ordinary with PU kitties as he now has a larger urethral opening that can get bacteria inside. The vet said that he may need to go on a round of antibiotics once / month and I believe it.
He's got a UTI now, so obviously my method is not perfect. but we do the best we can.
Fortunately, he doesn't block now and it affects him very little. I give him valium when he needs it for bladder spasms as he tends to be a little stressed much of the time. He flares up a lot when I am working too much and not spending enough time with him.
His last UTI previous to this one he was on Clavamox (2 weeks), then Baytril (10 days), then Cefa Drops (which he had a reaction to), then Zeniquin (sp?) for 2 weeks. The Zeniquin finally knocked out the UTI and he was good for about a month I guess.
The vet had done a more detailed urinalysis after the round of clavamox and decided he needed another Antibiotic to work on the bacteria. That's what I suggest you ask for next.

A lot of the other advice here has been great.
The problem with crystals and UTIs and Cystitis is that it is often chronic, difficult to treat and difficult to pinpoint the reason why your cat is getting them. Vets just try to use whatever methods have worked on other cats and see if they'll work on yours too. It's very frustrating because it'd be nice to just have a cure.
I'll be calling the vet tomorrow myself for another round of antibiotics for poor Pippin. The zeniquin is hella expensive ($30+ for 7 pills which is a 14 day treatment) compared to baytril or clavamox, but it's worth it for my little guy if it helps.
Sorry for the novel. I hope it helps!

Devlyn

Thanks everyone for all the responses.

Sharky, I did call the vet today, and she said the blood tests they did was a complete blood profile. When I asked specifically for the name, she called it a "CBC & Chemistry"--and all the values were normal. They also did a Leukemia test when he first started having the crystals...it was negative. Is there something else I should have him tested for?

While I was talking to her today, she said that she believes he has Cystitis (though she's wanting to wait until the ultrasound for a final decision). But regardless, something has to be causing it to continue to recur.

Beandip...I'm sorry about your baby's trouble, but thanks so much for sharing it with me. Now this product that you're using--L-methionine--is this something that the cats can stay on indefinitely? And its totally safe??

I also tried my boy on raw. And he absolutely loved it, but after nine weeks, he was peeing blood again. I was using a powder that you mix into the raw meat. He really exceled on the diet (except for the urinary problems).

The 'simpler raw' that you are using now...is it something you buy or something you make? I'm actually reconsidering his prescription diet since it didn't really help (only postponed the problem). My vet is like a general practioner, and everything I asked her, she just really doesn't know (or maybe the vets, in general, just don't know much about this problem). But I feel like my baby needs a specialist, which I haven't been able to find in Georgia. But food has to be a major contributing factor...its the only thing that makes sense.

Beandip, for testing the pH yourself...do you just buy like fish tank pH strips...or is there a special kind for urine testing?

Thanks, Couch Kitty, I'm glad your darling is so much better now. That has to be a relief!

Devlyn, the emergency room vet said the same thing, so we kept him on antibiotics for six weeks. Then we followed up with two separate urinanalysis to make sure the infection was gone. Both came back clear. Since the last urinanalysis, its been about six weeks...and now he's infected again. This is so frustrating!! For his very first crystal episode last year, he was put on Cefa Drops. But they causes severe diarrhea. So since then, the vets always give him Clavamox. Would the more severe infection you were speaking about show up in a regular urinanalysis, or would a different test be needed?

One more question Devlyn...since your baby keeps getting the infections, is the vet saying this is something that he'll have to live with forever? Has he wanted to operate (my vet mentioned possible problems with bladder position, drainage, etc)?

And last...these prices are killing me. Can anyone confirm that these are regular prices or is my vet overpriced: I was quoted $275 for the ultrasound, and then if he has stones that need to be removed, its another $354 for the surgery, and that doesn't include after surgery antibiotics and pain relievers. Does that sound right??

Thanks again for everyone's help. I'm getting more information here than I have in the last FIVE veterinary visits! You guys rock!!

The hills c/d...was it wet or dry? my cat has a similar history(urinary issues froma very early age) he has a intolerance to anticbiotics so I keep a close eye to make sure hes ok...when he starts forming crystals on the c/d(maybe once every 6 weeks) I give him some vitamin c(discussed it with vet hes not current on taht treatment but since it works he said its fine) at his highest he tested over 8 ph(the vets system read only to 8)

Yes ( thou I am not Beandip) DL Methonine is something you can use regularly ... It is something quite benificial in UTI issues according to my vet...

if it is cystisis many on here have dealt with it and can advise .. my knowledge is limited to what I have read

Honestly I'm not sure about the urinalysis. What I remember is that when we moved to Baytril, the urinalysis cost more and she mentioned that there was a bacteria present that did not show up on the previous test. I'll see if I can find the bill with the info on it.

Pippin had an operation a few months ago. It was a Perineal Uresthrostomy. That's a long name to say that they removed his penis and moved his urethra up closer to his anus. Since male cat urethras are so narrow and funnel shaped, they risk blockage. My vet said that male cats must have pissed off god.
They also call it a sex change surgery since they give the cat a urethral opening more like a female cat's, which is much wider and more prone to UTIs.
While she didn't say that he would have this problem forever, she did tell me that he COULD. It's something I'm going to have to be very proactive about because I don't want my baby on meds all the time if it can be helped.

As far as the costs for ultrasound and stone removal I'm not sure. Pippin has never had stones (knock on wood) but he has had lots of vet visits and of course unblocking visits and subQ fluids and the PU surgery. This year alone I've probably spent about $3k.

BUT! His infections are less.. traumatic to him. He doesn't get the paralytic pain. He acts almost completely normal except for extra licking (I wouldn't even call it excessive really) and more trips to the box. For the most part he's happy and relaxed. If I wasn't constantly paranoid, I probably wouldn't notice his illness.

Devlyn

Originally Posted by SouthernGem22

Thanks everyone for all the responses.
Devlyn, the emergency room vet said the same thing, so we kept him on antibiotics for six weeks. Then we followed up with two separate urinanalysis to make sure the infection was gone. Both came back clear. Since the last urinanalysis, its been about six weeks...and now he's infected again. This is so frustrating!! For his very first crystal episode last year, he was put on Cefa Drops. But they causes severe diarrhea. So since then, the vets always give him Clavamox. Would the more severe infection you were speaking about show up in a regular urinanalysis, or would a different test be needed?

One more question Devlyn...since your baby keeps getting the infections, is the vet saying this is something that he'll have to live with forever? Has he wanted to operate (my vet mentioned possible problems with bladder position, drainage, etc)?

And last...these prices are killing me. Can anyone confirm that these are regular prices or is my vet overpriced: I was quoted $275 for the ultrasound, and then if he has stones that need to be removed, its another $354 for the surgery, and that doesn't include after surgery antibiotics and pain relievers. Does that sound right??

Thanks again for everyone's help. I'm getting more information here than I have in the last FIVE veterinary visits! You guys rock!!

Click to expand...

I think Devlyn is talking about a "culture and sensitivity" test on the urine. It would pinpoint the exact bacteria present and then the best antibiotic for the job can be given.

The methionine...

Yes, it's safe and can be given long term. Anything can be overdone, though. Since it manipulates the pH of the urine (lower pH, more acidic), it can push it into a range that would produce the opposite type of crystal (calcium oxalate). The oxalate crystals typically form in a pH of less than 6.0. Some theories say that some cats are predisposed to oxalate crystals, meaning given the opportunity they will form (in those cats). It seems that some cats do not form oxalate crystals, even if their pH is low. It's very confusing, I know.

It is commonly found in cat foods, for this purpose (urine acidification). As a supplement, it's available in several forms.

Methigel - goo in a tube, similar to hairball medicine. Beandip hated it.

Chewable tablets - most cats like the taste of these, even mine do. I get them from here:

http://www.drsfostersmith.com/produc...pc=1&N=0&Nty=1

I think the brand names Ammonil and Methio-tabs have a similar taste and are probably well accepted too.

L-Methionine - just like "DL"-Methionine but the "L" form is "naturally" produced, while the DL is synthetic. The L form is available at most health food stores. I have used the Solaray brand. The natural stuff has a bit of a smell to it, as it's produced by a fermentation process, i.e. it smells kind of like mold to me. Consequently, my picky boy wouldn't eat it mixed in his food, so I pilled him. I had to put the powder into smaller capsules, as the big human sized pill is too big for a cat to swallow. I do know of cats that are willing to eat the medicated food, though.

The methionine was finally the "thing" that got us over the edge. Prior to that, he was about as active as a lampshade, very anxious, and slept under the bed, almost exclusively. After that, the transformation was unbelievable. I had forgotten what the old Beandip was like.

The raw was a close second, it helped a lot. Everything else we tried has proved to be unnecessary and not helpful.

In the case of struvite crystals, I believe that there is a cycle of crystal formation, inflammation (cystitis), pain, and infection that all hinges on urine pH. Some cats are more sensitive than others. I do believe that the Rx food helps the more common cases...but like I said, it didn't help Beandip.

The "simpler" raw is the recipe here (the one *with* bones).

http://catnutrition.org/recipes.html

Dr. Lisa Pierson has a slightly modified version of that recipe at www.catinfo.org.

Since I blew my electric grinder fund on a big freezer (for more meat!!), I'm still hand cranking the chicken and bones. It's not so bad.

A lot of what I've read says that a lot of vegetables (maybe just green ones, I don't recall) have an alkaline effect on the urine...that (and some things that Sharky said) motivated me to get off the Nature's Variety. It was a good starting point, though...and it did push us in the right direction.

The urine testing...actually I have not succeeded at testing Bean at home. He keeps his rear about 2mm off the litter. There are tricks to get around that but I haven't tried. I take him to the vet for that. I think you can use the fish tank strips, or I've also seen the strips at the health food store (they are marketed as being for urine). I think there are places online where you can get the strips that do the "whole" test, just like at the vet...but I'm not sure.

Yes things like spinich can be an issue( more to come on that as I dont have the book in front of me...lol.. dont have them all memorized yet)

I'm taking my boy to the vet for the ultrasound tomorrow, so I'll let you all know what we find out.

Beandip, I did want to share this for getting urine samples at home. I bought a clean litter box and one 5lb bag of gravel (the polished kind for a fish tank). Clean the litter box and the gravel thoroughly with a water and mild bleach mixture (I filled the litter box with hot water, added about two tablespoons of bleach, and dumped the gravel in...letting the whole thing set for about 10 minutes). Then rinse throughly. You can spread the gravel into a large baking pan and stick it in the oven at 300 degrees to dry (takes about half an hour) or leave spread out on a towel overnight to dry.

My kitty wasn't at all hesitant to use the gravel instead of litter. And because the gravel isn't absorbant, I was able to easily draw up a syringe of urine and take it to the vet to test (though I had to go right away because, apparently, freshness counts were urine is concerned). After the litter is used, simply repeat the process--but rinse the urine out first, then add fresh water for the bleach.

Anyway, that's how I was planning to monitor my baby brats urine pH.

I'm also going to speak to the vet about the L-Methionine, depending on what the ultrasound shows. But I see that according to instructions on the link provided, that this should be given twice a day...that seems like a lot.

I'm also seriously considering the raw food diet again, though I'm not sure I'm up to 'grinding whole carcasses' (gagging at the thought!).

If the scan tomorrow doesn't show any stones, I'll ask for the Culture/Sensitivity test to see if they can determine what antibiotics would be best for him. He's still very lethargic, and doesn't look like he feels well--and he's been on the Clavamox since Saturday morning. So it could be that he needs something different or stronger.

Thanks again for all the info...at least I'll have a starting point for my discussion with the vet!

That sounds like an excellent plan for collecting a sample. Thanks for the detailed instructions.

One time I tried using dry Lentil beans as litter (it was suggested somewhere for sample collection). Pixel and Junior both ate some of the dry beans. No interest in peeing on them!!

I think the 2x a day recommendation for the methionine is to better control the pH throughout the day. My vet told me it could be given once a day. That's how I did it when I was having to pill him. He took it all at once. Now that he has tasty chewable pills, I just split the dose in half and give it to him when it's time to eat (2x a day).

Yeah, "carcass" doesn't paint a very pretty picture, does it?

Let us know how it goes at the vet if you can. I hope he'll be feeling better soon!

Beandip & Southern Gem 22; sharky:

Thanks for all the great details here.
You are not alone!!!
My girl ikitty is also in the same boat as yours.
Getting a UTI repeats every 3 wks.
Trying also to get under control.
My question on this what is best or
explain difference between
the use of Carpon or the Methionine (I
ordered Monday the Dr Smith chewables tabs and will be
delivered to me tomorrow) I used
the Carpon for the past couple months;
with pretty good results.
Also do youuse the Carpon / Methionine
everyday or just when they have a UTI infection?
Brenda

Originally Posted by Ms.Blackie

Beandip & Southern Gem 22; sharky:

Thanks for all the great details here.
You are not alone!!!
My girl ikitty is also in the same boat as yours.
Getting a UTI repeats every 3 wks.
Trying also to get under control.
My question on this what is best or
explain difference between
the use of Carpon or the Methionine (I
ordered Monday the Dr Smith chewables tabs and will be
delivered to me tomorrow) I used
the Carpon for the past couple months;
with pretty good results.
Also do youuse the Carpon / Methionine
everyday or just when they have a UTI infection?
Brenda

Click to expand...

I'm sorry to hear that your girl is having this trouble. How old is she? Do you know what her urine pH has been? I don't have experience with the carpon. The methionine will lower the pH, so it's important to only give it if the kitty's urine pH runs above normal (there can be bladder issues without a high pH)....although I believe that oftentimes when there is bacteria there is also an elevated pH.

In my boy that had chronic issues, I am using the methionine every day for the time being. I had tapered down some, but like a moron I fed him something different for one meal (!) and he started acting weird after that so I had to take a step back.

Her Ph was 6.5 She is about 4, Not sure exactly; was a stray.
Very bad health when I rescued her about age 1 1/2.
HAs has been having this problem about a year now.
I am going to get the test strips at local drug store
for people, I assume they work on cats and try
to see what it really is again and test her once a week
to see what is going on exactly.
She has had the complete testing's blood work
senseativity (sp?) testing, antibotics for weeks on end.
Special food etc. I kind of think that stress
can be after in her case.; she is a little nervous &
is home alone for 12 hrs a day. I do have
radio on for her now, but that has not helped either.
What about Feliway? I was going to invest in this also,
cant hurt.
She is eating about 80% plus canned food now.
I am going to up to about 95%.

does your kitty have crystals or a bacterial UTI? i was a little unclear on that. the ultrasound is a very good idea. raven had one when he was around 2 or 3 yrs old and was having chronic UTIs of unknown origin.

raven is my "million dollar cat". he's had urinary tract problems since he was about 1 1/2 years old. he had struvite crystals when he was around that age, and again 6mo to a year later. but mostly he's had the cat equivalent of "interstitial cystitis". when he was finally properly diagnosed, he was put on Amitriptylene, Cosequin, and a prescription (dry) diet. i admit i still fed him over-the-counter wet food, but when he was in the height of his problems i used Pro Plane for urinary tract health for his canned food. they test for urine pH with that food, and it's target pH is 6.3.

the Amitriptylene really helped. after 3-4 months, a move, and consulting with a cat specialist we were able to wean him off the Amitriptylene and he's a "normal" cat now. he eats a mainly canned food diet. he won't eat the Cosequin anymore, so we stopped that a few years ago. i still carefully monitor the size of urine clumps in the litter box given my cats' histories with urinary health. i also use a Feliway diffuser.

Hi all,

Just back from the vet and more frustrated that EVER!!!

Good news: the ultrasound showed absolutely nothing...no physical abnormalities, no stones, not even any debris in the bladder. So far so good.

As the woman that was doing the ultrasound was packing up, I stepped over to Grace's chart and I read the entire report she had written on Grace.

Grace's kidneys are on the small side. Normal range ends at 3.5 centimeters (on the small end). One of Grace's kidneys is 3.6 and the other is 3.3, but the ultrasound person said that was still okay, and not a problem. On her report, she said that there was a SMALL possibility of Grace having "Pyelonephritis", which is an infection that is in the kidneys, but travels to the bladder and produces the classic UTI's that we see. However, in the report, she said that this was highly unlikely, since Grace has small kidneys...and one of the symptoms of that disease is enlarged kidneys.

So when my vet came in later, she said that she thought Grace probably had "Pyelonephritis". And that she wanted him on a medicine called "Amytripiline"...which, she informed me, could potentially cause blindness. When I confronted her about reading the report, she said that I misunderstood what I had read (I did NOT). She said what it meant was that Gracie HAD pyelonephritis, and it was beginning to clear up now, but that because she still had it, her kidneys were shrinking.

UGH!!!

Right now, Grace is on two weeks of Clavamox, and then I have a prescription for two weeks of Baytril.

Oh, and I did mention the possibility that even though Grace has a pH of 6.5, that maybe his needs to be lower. And I brought up the L-Methionine...and before I could even complete my thoughts, the vet was telling me "no", because she doesn't believe in urine acidification.

Then I asked if she knew where I could get some urine pH strips, because since there was no real cause for his infections, I wanted to watch his pH at home to see if it increased before his infections each time. She said no, that she didn't want me home monitoring. When I explained that I wasn't trying to replace her urinanalysis, just monitor for my own benefit, she again said that she didn't want me to do that, and then she changed the subject.

I fumed all the way home, and I'm going back tomorrow to get a copy of Graces whole file...I want a second opinion.

But I'm curious...what do you all think? Am I over-reacting, or was the vet being a pain?

Your vet was being a pain. I would get a second opinion, too.

Many vets will probably think that 6.5 is "fine", but IMO the other test results don't lie. If there are struvite crystals present at 6.5, then 6.5 is NOT fine. Grace has crystals in his urine, off and on...is that right?