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Conflicting second opinion: UTI(?)

post #1 of 19
Thread Starter 
I brought Ramsay (2.5 year old neutered male) to an ER vet earlier today as I suspected that he had a partial blockage. Since yesterday he has been straining to urinate. He goes to the box several times and hour, squats for 2-3 minutes and leaves a clump of urine/litter behind about the size of a grape. He has no other symptoms. He has not gone out of the box, does not cry when trying to urinate, he's still playful, eating, drinking, etc. He has no history of UTI, but I know how serious it can be, so we took him in right away. Now, here's where I get really confused.

ER vet:
Vital signs were all good. Bladder was enlarged. Gave Ramsay pain medication and put under sedation and tried to express the bladder and establish a good stream but was unsuccessful. Diagnosis was likely obstruction of the urethra. Method of treatment was to catheterize and flush urethra and bladder, take a full blood panel and keep him overnight for fluid therapy and in case of reblockage. After seeing Ramsay unsuccessfully attempt to urinate 2-3 times while in the clinic determined treatment should be immediate.

The price quote was VERY high, and the vet gave us another clinic close by in which we could transfer him to for the catheter and overnight hospitalization.

Vet 2:
Did not feel the bladder was enlarged when we arrived. Catheter passed "with ease". Bladder was drained and 3cc's were collected. Sample showed a microscopic plug containing mucus and crystals, as well as red blood cells. Urine was concentrated and cloudy. No free floating crystals were seen otherwise in urine. Vet did not feel that Ramsay was blocked, but had severe cystitis with straining causing him to pass only drops of urine. Ramsay received an antibiotic injection as a precautionary measure from the catheter, and Prescription Diet s/d, and was discharged. Recommends recheck of urine in 2 weeks.

So, that information was very conflicting in my mind, and I'm wondering what other peoples experience have been. I have never had a cat with this problem, so my knowledge is minimal. I don't know which vet was correct, and my regular vet is 4 hours away at the moment.
post #2 of 19
It's interesting that the first vet felt the bladder was enlarged yet the second didn't....however, perhaps the conflict there is more due to how one really interprets "enlarged"? I would imagine kitty's bladder was full, or at least had a good bit of urine in it (did Vet #2 comment on the volume of urine that was drained? - a little bit? a moderate sized amount, a fair bit?) perhaps when Vet #1 explained that it was enlarged, he wasn't necessarily saying it was "over-sized" but just such that it obviously contained urine.

What caught my attention was that the urine was cloudy...., plus the blood cells in it. Do you know if they did an in-house urinalysis or said they'd send it off to the lab for one? That should have been done, if it wasn' see if any bacteria was present.......though I suppose with the mucus present, that could cause cloudy urine too. Surprised Vet didn't give kitty some SubQ fluids..if the urine was so concentrated.......would be surely a good thing for a cat w/ crystals and the issues kitty was having, to get some extra fluids help flush things out good. Or did Vet?

Sounds like the treatment was good though; prophylactic antibiotic shot (that's good because there's always a risk of introducing bacteria into the urinary tract when you insert a catheter up there).....the diet.....and to re-check urine in 2 weeks. The only other thing that might have been good would have been to put kitty on a week of broad-spectrum antibiotics - in the event that there was an infection there.

Was the s/d dry or canned? Always best in kitties w/ urinary tract/crystal issues to be on a diet of canned food vs dry as canned food is up to 65% water and that helps to keep things flushed out better. However, from what I've read from folks, most cats don't generally "like" the canned prescription diets all that much.

So was it dry or canned? If only dry, you could go back to probably any clinic and get some of the canned food of that type, and try it as well.

Of course, as it's already clear that you know, keep a good eye on kitty....seems you have a pretty darn good handle on this, though - which is awesome. I used to have a male cat years ago who would block up and the first signs were frequent trips to the litterbox, straining to pee, peeing only tiny dribbles then back to the box, licking his genitals frequently and hiding........that's when I knew he was blocked and it was an emergency situation, to the vet!
post #3 of 19
Did the vet see what kind of crystals he has?
My sisters cat was that way and he got s/d but he got worse.
It turned out he had oxide crystals and he needed surgery. This was about a month ago.
Can you ask the vet to find out what they are.
Did they do a ultrasound?
My Coco had bladder stones and crystals with ecoli before.
The s/d worked for her but she had struvite crystals.
post #4 of 19
Thread Starter 
Sorry, yes, struvite crystals.
post #5 of 19
That should should work for him.
It worked well for Coco.
post #6 of 19
Thread Starter 
did Vet #2 comment on the volume of urine that was drained?
3cc of urine was drained with the catheter.

Do you know if they did an in-house urinalysis or said they'd send it off to the lab for one?
They did it in-house.

Was the s/d dry or canned?
It is the dry s/d. We have a hard time getting him to eat wet food, though after reading about FLUTD all night we will probably be switching him over to a primarily wet diet.

I guess the routes of treatment between the two vets were so drastically different that we're worried we went the wrong way with things.

Also, if anyone could recommend foods or direct me to other forum threads on foods people are feeding for cats prone to cystitis and UTI. I'm having a difficult time finding them, and I'm not convinced feeding the s/d long term is the best option.
post #7 of 19
S/d should only be given to get rid of the crystals.
Coco had it for 2 months then was switched to c/d and royal canin urinary. She was on it for 2 years.
Make sure your cat drinks alot of water.
Did they do a culture also?
post #8 of 19
You might want to take a look at this thread:
post #9 of 19
Thread Starter 
How long should I expect him to continue frequent trips to the box?
post #10 of 19
Kandie s UTi s usually about 5 days on the antibiotics

Pj within a couple days
post #11 of 19
Originally Posted by whiteforest View Post
How long should I expect him to continue frequent trips to the box?
Well the problem in your situation's very possibly kitty has a urinary tract infection -- but the vet didn't give you a prescription for antibiotics; they only gave a one-time shot yesterday. Why you weren't given a course of antibiotics, I don't know. I'm sure there's some irritation to the urethra/urinary tract from having had the catheter ............ but if the frequent trips to the litterbox are continuing, I'd be going back to the/a Vet soon as possible...........if this isn't due to there being a UTI, it could be that kitty is blocking up again, due to the crystals/mucus. Why the Vet didn't give kitty fluids is beyond me...........with cloudy/concentrated urine and crystals, fluid therapy was critical. Seems hard to find a good and thorough Vet these days, sheesh.
post #12 of 19
Both vets arrived at pretty much the same conclusion, the primary difference was the urgency. The second vet's diagnosis may have been somewhat tainted by the procedure at the emergency clinic. It sounds to me like your cat is getting appropriate care, but you'll want to keep a close eye on how much he's urinating; it's possible he could still obstruct as there will still be crystals in his urine for a while.

When Twinkie had crystals, the prescription food cleared up his urine in a month. He wasn't obstructed though and the crystals he had were fairly small and not all that dense. I guess you just have to keep him on the food until his urine is clear again and the pH and specific gravity are normal.

There are four different brands of prescription urinary crystals food, in both dry and wet. If your cat doesn't like what the vet prescribed, you can try one of the others.

Diagnosis is more of an art than a science, it seems to me. And that's why two different vets can come to different conclusions. I think the main thing is that he's getting treated now.
post #13 of 19
Thread Starter 
The vet that gave the antibiotic injection told us that it would last for 7-10 days. The diagnosis at the second vet was severe cystitis and said a "microscopic plug" came out in the urine sample when she put the catheter in, but that she didn't feel he was blocked.

He is eating the dry s/d fine, and drinking more water than usual. I will probably water down a small amount of wet food tonight (he only likes "gravy") to encourage him to take in an extra ounce or two of water. He is going to the litter box less frequently today than he was yesterday and the clumps are about twice the size they were, so I'm assuming that it a good sign.

I plan to call my regular vet in the morning and tell her everything that the others told me, but we won't be able to see her for another week.
post #14 of 19
Things are looking up!!
post #15 of 19
During my last ER trip with Muddy, they also catheterized him and kept him for about 36 hours. It sounds like you have a similar problem as my Muddy. He's seen 4 vets now in the last 4 months and each vet will have their slant on urinary problems.

Inflamed bladder can trigger crystals, or crystals can cause an inflamed bladder. If they catheterized him and drained him that way, it could have provided relief to his bladder.

Muddy like wet food, but won't touch the S/D. He gets a urine deacidifier instead of the S/D to neutralize his urine. When the PH is off, it can also trigger crystals.

If you haven't had one yet, an ultrasound is a good idea - it is better than xrays to spot things like stones, although some vets swear by xrays.

Muddy was given sub-q's every time he's been to the vet. The vet also sent home bags of fluid to administer to him at home if he gets close to blocking. That's another thing you might want to talk to your vet about. They are scary to administer if you've never done it before, but the alternative is much worse.

If you are going from vet to vet, ask for any test results/diagnosis/prognosis in writing from each vet then bring a copy to the next vet. My vet #3 caught something that vet #1 prescribed that wasn't right for him.
post #16 of 19
Originally Posted by whiteforest View Post
He is eating the dry s/d fine, and drinking more water than usual. I will probably water down a small amount of wet food tonight (he only likes "gravy") to encourage him to take in an extra ounce or two of water.
sounds like a good plan - maybe puree the food+water combo to make it more gravy-like? [like in a blender or something...]
post #17 of 19
Thread Starter 
Thanks! When I take him to our regular vet for a followup I will definitely ask about doing an ultrasound and getting fluids to have on hand. I used to vaccinate and microchip at a shelter, so I'm okay with needles.

And he did eat the slurry I made for him, about 3tbsp of it. His last trip to the litter box yielded an almost normal amount of urine.
post #18 of 19
You can really see alot with the ultrasound.
I hope the shots last with him.
It only lasted 3 days with Coco before she was in the pan screaming.
post #19 of 19
Thread Starter 
I am SO spoiled with my regular vet. She called me this morning to check on Ramsay! The ER vet must have faxed them the file, because I was a little confused at first as to how she even knew yet. At any rate, she thinks he seems to be doing well now and scheduled him an appointment for the 26th.

Thank you again to everyone who's given advice an information.
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