Struvite Crystals...UTI...so confused

catmom2wires · Nov 22, 2011

Hi everyone,

Brillo is having some issues. About 2 weeks ago, she (and we're 99% sure it's her as the urine has no "boy smell" at all) peed on a baking sheet on the kitchen counter. I drew the urine up in a sterile syringe and had it tested at the vet's, who said the pH was 8.5, and the urine contained leukocytes and struvite crystals. Brillo was given a course of cephalaxin and I was told if she didn't improve, to bring her back in.

Well, today is day 10 of treatment, and she once again provided a sample on the kitchen counter. I took it in and they called me back a few minutes ago and said there is no improvement. They recommended a different antibiotic, x-rays if she doesn't improve and CD diet for life! UGH!

Brillo has eaten a combo of TOTW kibble in the morning and raw diet in the evening since I've had her (over two years). I have changed her to 100% raw, and have added extra water to her food each feeding. Of course my vet is not supportive of the raw diet (they push Science Diet). I talked to the woman I order my raw food making supplies from, and she recommended I get a second opinion or simply continue to feed the raw, use the new antibiotic, and see what happens.

Brillo is not showing any signs of discomfort. She is not a "frequent flyer" with the litter box. The urine I've collected has been clear and yellow, with no blood or bad odor. She is not licking her vulvar area, and the urine puddles she does provide are full bladders full. It's all very confusing. As a side note, neither of the boys show any signs of infection either.

At this point, I am leaning toward using the new antibiotic, but "soldiering on" with the homemade raw diet at this point. If she provides me a new sample, or shows any sign of discomfort, I will take her for a second opinion across town. Does this sound reasonable? I really abhor the thought of using the CD, as I did with my first kitty, Hannah, and she never seemed as healthy thereafter.

Any other suggestions or experiences anyone would like to share?

Thanks for reading,

C

sugarcatmom · Nov 22, 2011

Brillo's urine sample was quite alkaline when tested, which would be a risk factor for struvite crystals. My suggestion would be to get some ph test strips from a health food store (sometimes pharmacies have them too) and test her urine at home if you can. Ph fluctuates throughout the day, but if she's consistently above 7.0, you might want to think of adding an acidifier (like L-methionine) to her diet.

Also, after this round of antibiotics I would recommend taking her to the vet to get a urine sample via cystocentisis, and request that it be sent out to a lab for a culture and sensitivity. That's the only reliable way to know whether there truly is bacteria present, what kind they are, and what antibiotic would be most effective.

And definitely don't feed her CD! Ick ick ick!!! You're instincts are good on that one.

Good luck!

darlili · Nov 22, 2011

My boy had struvite crystals. My opinion....get your vet to draw a sample (if it were me, I'd get a blood panel done at the same time, just to be sure nothing else is happening). And, you're not going to like this - if the vet suggests a trial of C/D (or starting with S/D, then C/D for maintenance), followed by another urine sample - why not do it? C/D has worked for hundreds, if not thousands of cats (including my own). I know there are people who have knee jerk opinions of Hills and/or Science Diet - but, in my case for my boy - I trust my vet, and I trust the lab results we've gotten in the last two years.

IMO, using the antibiotics but not working with the vet's prescription in whole is not productive - for you, the vet, or, most importantly, your cat.

auntie crazy · Nov 22, 2011

Originally Posted by CatMom2Wires

...

Brillo is not showing any signs of discomfort. She is not a "frequent flyer" with the litter box. The urine I've collected has been clear and yellow, with no blood or bad odor. She is not licking her vulvar area, and the urine puddles she does provide are full bladders full. It's all very confusing. As a side note, neither of the boys show any signs of infection either.

At this point, I am leaning toward using the new antibiotic, but "soldiering on" with the homemade raw diet at this point. If she provides me a new sample, or shows any sign of discomfort, I will take her for a second opinion across town. Does this sound reasonable? I really abhor the thought of using the CD, as I did with my first kitty, Hannah, and she never seemed as healthy thereafter.

Any other suggestions or experiences anyone would like to share?

Thanks for reading,

C

I would do as you are doing. Crystals are a natural part of the cat's urine, however, they begin to precipitate as soon as the urine leaves the cat's body so any reading your vet gets from the two samples you brought in are pretty much guaranteed to show crystal formation. To my mind, that nullifies the results of those tests.

A sample pulled via cystocentesis is really the only accurate way to check a cat's urine.

As for the PH itself, I don't know how it changes once the urine has left the body, but raw meat diets are naturally acidifying, so putting Brillo on fully raw is a good step there, too.

Cat's who urinate in curious places often have cystitis of the bladder, or bladder inflammation, which can have several causes. Stress is a big one. Has anything changed in Brillo's environment lately? More visitors than normal, schedule change, construction in the neighborhood, new cats hanging around, etc? Dr. Hofve has an article on LittleBigCat.com I think might be helpful / interesting to you: Urinary Tract Disorders in Cats.

Good luck tracking down the cause of Brillo's discomfort! Peeing on the counter is a doozy of a behavior to have to deal with! <<hugs!!>>

AC

otto · Nov 22, 2011

Antibiotics will cure urinary tract bacterial infections. They will do nothing for high pH or crystal formation.

A cat often has some other issue going on (crystals, stones, inflammation) in addition to the UTI. The pain and irritation and frequent trips to the litter box cause her to wash too often, and that is what brings on the bacterial infection. Antibiotics will help that. Antibiotics will not help with inflammation or any kind of crystals. Other causes of UTIs can be dirty litter boxes and obesity.

If there is no bacterial infection, there is no point in antibiotics, regardless of pH or amount of crystals in the urine. If bacteria is present, and the infection is not responding to the antibiotic prescribed, a culture should be done, to determine the most effective antibiotic. A culture should be the first thing done, not two or three different antibiotics tried, then a culture.

And, as was mentioned the urine should be taken directly from the bladder, even if kitty needs to be left at the vet for a few hours to wait for her bladder to fill up.

Hope you can get to the bottom of this for your little girl. Remember that cats hide pain instinctively. That she shows no sign of pain, does not mean she isn't having any. Peeing on the counter is her cry for help, good job responding to that cry.

farleyv · Nov 23, 2011

Please don't dismiss CD. Beeba has been on it two years. And after two flareups of crystals before it, he is 100 percent now. I don't fancy dry kibble any more than the rest of you, but it does have it's place in preventing crystals.

I consider it medicine.

I hope Brillo clears up. She is so lucky to have you taking care of her.

otto · Nov 23, 2011

farleyv said:
Please don't dismiss CD. Beeba has been on it two years. And after two flareups of crystals before it, he is 100 percent now. I don't fancy dry kibble any more than the rest of you, but it does have it's place in preventing crystals.

I consider it medicine.

I hope Brillo clears up. She is so lucky to have you taking care of her.

Mazy too is kept healthy on the prescription c/d and I am very thankful for it. It's the only food that keeps her healthy, and I have tried premium grain free canned diets with her.

catmom2wires · Nov 23, 2011

Thanks for the input everyone.

Yes, I understand this whole situation sounds a bit weird (not like I usually like to handle things.) The first urine was found on the night before I had an early morning flight to Florida, so I had to have my neighbor take in the sample I drew up. Since I was gone for 4 days, the treatment was begun without me being able to properly review things. When I came home, I realize that the vet who tended to her was the one I absolutely refuse to see my pets. So, I'm not surprised this antibiotic didn't work (he seems to choose obscure things for relatively simple problems).

Yesterday's sample was much older, and it had actually begun to dry around the edges. I don't think it was a good one. However, my preferred vet made his recommendations and I will continue to follow them, except for the CD. The ONLY reasons I am not doing CD right now is because there are ZERO signs, other than the inappropriate counter-peeing, that there is a problem. Brillo is lively, eats well, is taking her extra fluids well and when she uses the box (or counter) it is a full bladder full. She is upstairs with me from about 7 pm until 6 am every night without getting off the bed---so clearly she isn't uncomfortable trying to pee all the time.

Thank you for the link, Auntie Crazy. Yes, there has been lots of stress in the home. We had our floors redone, which was a long stressfull event for everyone. My daughter is 14---enough said! The neighbors' are doing an addition to his home, and there is a lot of noise and banging around. Also, I have been petsitting my neighbor dogs and although Brillo grew up with them, they seem to stress her out a bit. Brillo's brother, Ziggy, demonstrates his stress by peeing as well, and takes prozac for that...so the stress could be causing her bladder irritation.

So, since yesterday, I have begun patrolling the litter box, and all pee clumps are LARGE and normal looking/smelling. I added a bowl of water on the bathroom counter, so Brillo can have access to dog-saliva-free water, although she's yet to drink from it. I am SUPER watering down her raw food, and I have purchased l-methionine to add to her food to increase acidity.

If I see any reason to think that these measures are not working, I will take her to a new vet. This new one is a friend, and I generally don't like to mix friendship with business (especially since she is reputed to charge sky high fees). However, after talking to her socially about her practice, I really feel she is the most skilled vet in my town.

Thanks again for the input. Little Brillo thanks you, too.

Happy Thanksgiving.

Cally

otto · Nov 23, 2011

Sometimes we have to put our personal feelings aside when deciding what's best for our cats. I understand you dislike the c/d, but it may be just what her body needs to keep her urine pH regulated during all the stress. When things get back to normal you could put her back on her raw diet.

I can't stress enough that cats HIDE pain and illness. The c/d does what it is designed to do, keep a cat's urine at the proper healthy pH and prevent crystal formation. It wouldn't hurt Brillo to be on it for a couple of months. However a couple of months of 8.5 pH and struvite loaded urine could do permanent damage to her kidneys and urinary tract.

Just something for you to think about.

Oh, and if you don't have any, get some feliway diffusers and keep them running. That will help her cope with the stress.

:vibes:

Brillo.

sugarcatmom · Nov 23, 2011

otto said:
I understand you dislike the c/d, but it may be just what her body needs to keep her urine pH regulated

There is nothing magical about C/D. It has an acidifier added, to make up for the alkalizing effect of all those highly inappropriate carbohydrates, and the kibble has extra salt to try to get cats to drink more (in order to make up for the dehydrating effect of DRY food!). It just makes more sense to feed something cats were "designed" to eat in the first place rather than attempting to retrofit an inferior product to fix a health condition. If for whatever reason a cat can't maintain proper urine acidity even when fed the appropriate food, it's so much better to add your own acidifier to their diet. Otherwise you could just be swapping one health condition for another (you'd be amazed how many cats eating C/D come down with diabetes).

Oh, and anyone who thinks Hill's does all this wonderful unbiased research in the name of better health for our pets should read the book "Not Fit for a Dog".

catmom2wires · Nov 23, 2011

Thanks Otto,

I do have 3 cans of C/D in the house, so I can, and will, use it if I feel it is necessary. Thanks for reminding me about the Feliway--I need to order more refills for my diffusers. Sadly, I think my dogs are a large part of the stress. One in particular barks--A LOT. Some days it makes ME want to pee on the floor or counters!!!!

Has anyone tried the flower essences for relieving stress in their kitties? They sound interesting and I already have Rescue Remedy here in the house.

Thanks again,

Cally

darlili · Nov 23, 2011

As I understand it, any prescription food has to be used on an ongoing basis, or as directed by a vet - just tossing a feeding in here or there solves nothing. It's like a human taking the odd shot of insulin now and then to treat diabetes - just doesn't work. Forgive me if I misunderstand your intent - but three cans of C/D isn't going to last very long.

Has the cat been in for a urine draw yet? I honestly think that's the place to start, as well as getting a whole blood panel done. And please keep your vet in the loop no matter what you do re diet - she can't work out an appropriate treatment if she's kept in the dark as far as compliance with her entire prescription.

As Otto says, cats are wonderful at hiding their discomfort. The peeing on the counter, to me, indicates your cat is extremely uncomfortable and is doing everything she can to tell you she needs help.

catmom2wires · Nov 23, 2011

No, I realize that once the C/D is started, it needs to continue. I would have a few day's worth to get me started if needed.

No, the draw isn't scheduled, nor has my current vet suggested it. He just suggested x-rays to see if there is a stone.

Brillo's doing well on the clavamox. It apparently soothes the bladder as well as kills bacteria. She's eating/drinking/peeing/playing just fine right now. As always, I will continue to watch her like a hawk, and if nothing else, I do realize I need to see a different vet.

Thanks again for the input.

Cally

ilovemia · Nov 23, 2011

Sugarcatmom said:
There is nothing magical about C/D. It has an acidifier added, to make up for the alkalizing effect of all those highly inappropriate carbohydrates, and the kibble has extra salt to try to get cats to drink more (in order to make up for the dehydrating effect of DRY food!). It just makes more sense to feed something cats were "designed" to eat in the first place rather than attempting to retrofit an inferior product to fix a health condition. If for whatever reason a cat can't maintain proper urine acidity even when fed the appropriate food, it's so much better to add your own acidifier to their diet. Otherwise you could just be swapping one health condition for another (you'd be amazed how many cats eating C/D come down with diabetes).

Not all cats can eat what they are "designed for" due to health problems. We need to be more accomodating so they can lead as healthy of lives as possible. I dont believe you have a veterinary degree. Therefore I dont think you can make the decisions the vet can about how to treat UI's.

darlili · Nov 23, 2011

S/D and C/D are two separate foods, prescribed separately - S/D is never, as my vet, and Hills, explain it, to be used long term. C/D is the maintenance food.

ldg · Nov 23, 2011

Perhaps the mods should split the above post into a new discussion in the nutrition forum, because there is much misinformation that perhaps some would like to address that have nothing to do with Brillo's situation.

But comparing choline chloride to "salt" (sodium chloride) is just ridiculous:

YayHappens said:
The choline chloride a bit further down is yet another type or class of salt that, I suppose in this application, would be used to control any possible internal infections from occurring or hopefully recurring. It's sort of like an anti-microbial soap humans would use when we wash our hands. But this ingredient affects them internally.

Choline Chloride=Salt??????? Choline Chloride=antimicrobial soap??????????????? Where are you getting this information?

Choline is not technically a vitamin, but is considered a part of the b-complex and is classified as an essential nutrient. Its chemical composition is (CH3)3N+CH2CH2OHX−, where X− is a counterion such as chloride, hydroxide or tartrate. Yes, as "Choline Chloride," the word "salt" appears, as technically it is a "quarternary ammonium salt," but among its many functions, choline is (according to the link provided to the OSU Linus Pauling Institute Micronutrient Information Center) "oxidized in the body to form a metabolite called betaine. Betaine is a source of methyl (CH3) groups required for methylation reactions. Methyl groups from betaine may be used to convert homocysteine to methionine. Elevated levels of homocysteine in the blood have been associated with increased risk of cardiovascular diseases." It performs many other functions, of course, but is essential to healthy liver function, and choline deficiency results in fatty liver.

http://lpi.oregonstate.edu/infocenter/othernuts/choline/

Choline chloride is an ingredient in MOST cat food. It is also used as a supplement in a lot of animal feed.

Here is the European Food Safety Authority Scientific Opinion on Choline Chloride, "Scientific Opinion on safety and efficacy of choline chloride as a feed additive for all animal species:" http://www.efsa.europa.eu/de/efsajournal/doc/2353.pdf

ldg · Nov 23, 2011

darlili said:
S/D and C/D are two separate foods, prescribed separately - S/D is never, as my vet, and Hills, explain it, to be used long term. C/D is the maintenance food.

YayHappens is referring to "SD" meaning Science Diet. The ingredients list is for c/d.

YayHappens: Science Diet is the brand name for non-prescription foods manufactured and distributed by Hill's Pet, which also manufactures and distributes prescription foods.

auntie crazy · Nov 23, 2011

CatMom2Wires said:
No, I realize that once the C/D is started, it needs to continue. I would have a few day's worth to get me started if needed.

No, the draw isn't scheduled, nor has my current vet suggested it. He just suggested x-rays to see if there is a stone.

Brillo's doing well on the clavamox. It apparently soothes the bladder as well as kills bacteria. She's eating/drinking/peeing/playing just fine right now. As always, I will continue to watch her like a hawk, and if nothing else, I do realize I need to see a different vet.

Thanks again for the input.

Cally

I am truly surprised this vet wasted your money and everyone's time "testing" aged, non-sterile urine that is, by definition, guaranteed to show both crystals and a high PH (thanks for the pm, my friend!), as both are naturally created as the urine ages and exposure to air causes C02 loss.

I am equally dismayed, 'though not as surprised, that he prescribed an antibiotic based on test results showing crystals but no infection (false reading or not). There is zero indication this cat has a bacterial infection and therefore, no reason whatever to throw antibiotics at her. In addition, ANY time antibiotics are used, a sterile urine culture (via cystocentesis) should be done to ensure minimum dosage / maximum efficiency - identification of the correct antibiotic for the job right from the start with none of this "let's try this one, let's try that one" nonsense.

Contemplating a drastic switch to low-quality, unhealthy kibble in an attempt to "fix" the known-to-be erroneous test results makes no more sense than throwing antibiotics at the cat. In fact, I wouldn't even bother administering l-methionine, as there is no real indication this cat has an incorrect PH level. Not to mention, the switch to an entirely species-appropriate raw diet will naturally adjust the PH even if it happens to be off from the kibble she was previously eating.

Based on the high volume of chaos currently present in Brillo's environment, and the fact that two thirds of urinary tract issues are bladder inflammations often provoked by stress, it makes a whole lot more sense to address the stress level poor Brillo is suffering under.

Cally, for peace of mind, you might want to bring Brillo in for a cystocentesis (but not to the same vet - it's fairly clear to me he leans more toward padding the bottom line than actually curing the cat with decent quality care), but I would definitely put some focus on reducing the noise / chaos level as much as possible. Stick as close to a routine as possible and carve time out for Brillo to both get one on one time with you as well as be able to relax quietly by herself (away from other animals, loud noise, etc.) In addition, as has already been mentioned, Feliway can work wonders ('though not in all cases). You will need at least one plug-in per average-sized room and Amazon.com has the best prices on multi-packs.

At a minimum, Brillo is stressed and in pain (cystitis is very painful) and something needs to be done ASAP to address the problem and alleviate her pain. A new vet may very well swap out the antibiotic for a pain relief medication.

Best regards!

AC

yayhappens · Nov 23, 2011

Hi LDG,

You are stating that I said choline chloride = salt and that it also = antimicrobial soap and that is NOT what I said. I said that Choline Chloride is a class or type of salt. A compound yes, as I mentioned. You are correct, it is of the quarternary ammonium salts, which are in some cases used in detergents and cleaners exactly as I mentioned and has antimicrobial properties.

It does have many functions like you mentioned and in the formulation of c/d it appears it has multiple functions for cleansing. Is it the only function of its use? No. But you are referring to choline of the b-complex which is not the ingredient listed, and I am talking about choline chloride which is.

darlili · Nov 23, 2011

Thanks, LDG - I think I got confused by the reference to SD in the one post, since, as you know, a lot of times vets will prescribe S/D to start then transition to C/D.

To the OP, I have to admit I'm surprised, if I understand it right, that none of the vets you've spoken to have recommended a urine draw, at least post- antibiotics. When Dante was diagnosed, well, first he had some peeing issues (including in inappropriate locations) and as on Batril for a week, as well as a painkiller. Both my own vet (on getting the fax from the e-vet) and the e-vet recommended a urine draw about a week after we finished the antibiotics, absent any more acute symptoms. Fortuntately enough, my vet's practice has an ultrasound on premise - they tossed a scan in (it was around $25) as well. That's when he found some struvite crystals. Now, in Dante's case, C/D was prescribed, followed by a urine draw every two months for six months. Luckily, it seems diet resolved the issue quickly. Now we just do senior panels every six months, which include a draw - so far, so good.

I agree that C/D is a very dense food and you have to watch portion size. My Dante tends to gain weight, but my vet helped me work out portion size so he actually lost weight, in a healthy manner, on C/D. I guess I"m just happy that Dante (and Dharma) continue to get excellent senior panels and appear healthy during their six month check ups. For me, the proof is in the pudding, and a healthy cat equals a happy mommy in my house. Of course, I continue to do happy pee-dances when I see those nice big pee balls. BTW, on a side note, you might want to try a couple of brand new litter boxes and Cat Attract litter - some cats will associate the old box and/or old litter brand with the discomfort of peeing.

Happy Thanksgiving all, and hopefully no one needs to do an e-vet run tomorrow!

Struvite Crystals...UTI...so confused

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