Struvite Crystals...UTI...so confused

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!

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. 

 

 

 

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

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.
Edited by otto - 11/22/11 at 5:40pm

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.

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.

Brillo.

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".

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.

 

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.

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:

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
Edited by LDG - 11/23/11 at 4:11pm

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.

 

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

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.

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! 

Sorry, I edited the post. I should have just posted this separately:

Hi LDG,

 

Thank you. I will take a look at it. It could be very well possible that it is being used in the formulation for all of the above that we are both arguing for. Only the recipe makers will know for sure. I want to say that I am not disputing that it may provide value for organ support, but caution that it is not the only function or use for it. I will take a look at the safety report and I appreciate you providing the information. 

Actually Choline Chloride IS a form of choline, that's my whole point. "Due to its established nutritional role in domestic animals, choline chloride is regarded as an effective source of choline." EFSA report, p. 2.

Nobody said anything about magic . Brillo, the cat in this thread, is raw fed, and yet, here she is with this problem. I'm no expert about raw feeding but I do know it can be very dangerous for cats with urinary tract issues if the balance is off even a little. So then you have to add some chemical to make it better?

C/d may not be an ideal food but it does what it is supposed to do. My Mazy was on a canned diet when she first starting having urinary tract problems. I have, repeatedly, tried to get her back on a grain free canned diet. Whenever I do, she starts having problems again.

Sometimes it's about quality of life, for the cat. Do I want to constantly be running my cat to the vet for urinary tract problems? Have her always at the litter box, always feeling stress and pain? No, I do not. Cats live in the now. I want her to have the best life she can, now. For her, that means feeding her a less than ideal food. Because it does what it is supposed to do. Keeps her pH at 6.4 and keeps her urine free of struvite crystals.

My other three cats eat a varied, grain free canned diet. I wish with all my heart that Mazy could too. But, when she does, she gets sick. So I am very grateful that food is available to her.

By the way Hill's Prescription Diet is not Science Diet. Two different foods

Hi LDG,

 

On an efforted skim of the paperwork what I read in summary is; they state what choline does and what its benefits are. It then states that choline chloride is a an acceptable bioequivalent. And then it goes on to talk more about choline more and how choline is necessary. Mostly what I am reading about is choline and not really anything about choline chloride except that it is acceptable to use in feeds. The only thing supporting why it is acceptable, is just stated so far as : it's a bioequivalent.

 

It is difficult to trust some of the science reporting these days. The US Congress declared pizza a vegetable and then in Europe, the big pharma beaurocrat "studies" declare there is no proof that water prevents dehydration (lol)

 

 

... oddly when I went to go look up "choline chloride in cleanser" via the search engine, an opinion report from the same place came up: http://ec.europa.eu/health/ph_risk/committees/04_sccp/docs/sccp_o_132.pdf

 

 

Unfortunately they keep interchanging the word choline and choline chloride in different areas for both of the paperworks and it makes it very tasky to keep everything straight. Granted, the report I posted says that there is no little or no evidence that it would cause for irritation under a certain % in concentration (or something to that effect). I will note also out of the choline chloride opinion paperwork, there is no data submitted in all of the available sections to report its toxicity. There are so few real studies about cats, how can we say that it really may not cause damage or irritation over time to mucous membranes? And not even for all cats, just some cats who may be a little more sensitive.

 

edit: I will throw this one in there too, particularly for the section on health effects at the most severe end.

 

 

 

 

 

I apologize to everyone for the mixup in the food brands and the back and forth about the ingredient. I wasn't wanting to hijack the thread.

Edited by YayHappens - 11/23/11 at 5:20pm

The biggest thing here in my mind is a positive dX by xray or urinalysis. I might have missed a post and I apologize if I did. My mother has a stones kitty and I have a stones kitty so I do have at least a little knowledge of the area. My girl, a stray mackerel tabby cat rescued at around 4 weeks, at 3 yrs old had about 12 stones the size of small gems in her bladder by the time she showed symptoms, and she did NOT have an infection. She required emergency surgery the night she was dX'd if I hoped to save her, that was several months ago. She was on antibiotics only as a post-op precaution. It's important to identify the true problem, then educate yourself on dietary options. The rX foods are an excellent "holding pattern" food while you get to understand your specific situation. They may be an indefinite diet. My mother's cat has been off rX foods successfully for many years with no complications, on the other hand I don't dare take my recently dX'd kitty off of rX until I understand her case better. Both cases were confirmed 100% struvite stones with stone analysis.

I too am surprised that a sample has not been taken directly from kitty, and urine culture has not been done.

It is not a "bioequivalent," it is a FORM of choline.

Yes, and olive oil is used in many natural shampoos. And if I get it in my eyes, it will hurt and irritate them. Just because a vitamin or essential nutrient is used in external cosmetic applications does not mean it's dangerous if ingested.
Again, because choline chloride is a form of choline.
That is a 5% concentration.

Cat foods that include choline chloride: Weruva, Blue Buffalo, Taste of the Wild, Newmann's Own, B.F.F., Innova, Evo, Before Grain, Eagle Pack, Holistic Select, Natural Balance, Solid Gold... and perhaps THE most "super premium," and certainly one of the highest quality cat foods there is: Ziwipeak. Yes, choline chloride is an ingredient.

Given that Natural Balance limited ingredient foods are the primary foods used by cats with allergies, I'm going to have to think that with choline chloride as an ingredient, it's not an irritant to cats, or they would continue having problems, not have their problems resolved.

This is by no means scientific, but in the Truth About Pet Food, choline chloride is listed as an ingredient in many of the foods, and it's not raised as a "red flag." http://www.truthaboutpetfood.com/articles/how-to-understand-pet-food-label-ingredients-–-the-basics.html
Yes, and MANY vitamins and minerals have horrible health effects - if you have too little, or if you have too much.

 

(Text highlighting is mine.)

Just a slight clarification here - Brillo's diet has been half kibble / half raw. The kibble was only removed, and Brillo switched to a completely raw diet, a little over 24 hours ago.

 

AC

Okay I knew there was some kibble in the diet (TOTW) but I thought it had been longer than a day since it was removed. However, considering the stress factors reported, it's not difficult to see why Brillo is having problems. Since the stress cannot be removed, tweaking the diet is going to be necessary, IMO, but, as has been stated, a urine sample taken directly from the bladder, and sent to a lab for culture should be done, should have been done.

My concern with a raw diet remains that the phosphorous content is too high.

And yes, to answer the OP, Rescue Remedy may help, along with the feliway diffusers. Make sure it is the RR for pets though, as that formula contains no alcohol.

Hope Brillo feels better soon.