amitryptilene for struvite crystals?

Zach has struvite crystals. LOTS of them, according to the vet, and very alkaline urine.  He needs rx food for the rest of his life.  Yikes.

Here's the weird part: she sent him home with rx for tramadol (for pain, nothing weird there except he won't take it) and amitryptilene, "an anti-anxiety medication because this is a very stressful time for him" she said. As an RN I know that's not an anti-anxiety drug but rather an antidepressant (which can also be used for anxiety) and it takes several weeks to work.  It's not your standard short-acting anti-anxiety medication.  I expressed my concern and asked what the rationale was behind this. There's a theory that stress causes these crystals and he may need this to get through this attack and prevent another one.  I asked if it works faster in cats that he'd benefit from it during this attack and she said, "well, we've never been able to interview a cat to know for sure."  Awesome.

1.  To me this sounds like the most ridiculous garbage I have ever heard.  He's the mellowest cat I've ever known, and the only time I've seen him anxious was when someone was crushing his bladder and examining his urethra.  I don't want to put my cat on long-term antidepressant therapy especially when giving him pills is a nightmare.  Any advice?

2.  How does rx food work?  Is the purpose to acidify the urine, or limit the dietary magnesium, or both?  And if adding water to the diet is so important, why do they make renal rx kibble (first ingredient = corn)?

Thanks, y'all.  I'm upset over here.  :/  He's only 3 years old and we have a lifetime of this ahead.

Mrs. H

Forget the amitriptylene. It does help kitties with stress issues, sometimes, and it's sometimes a decent last resort for cats peeing outside of the box (because a side-effect is urine retention, and for some reason this causes some cats to start using the box again. :dk: It's used for children that wet beds, for example).

You may want to stabilize him on the RX food for a few months, but it is NOT what is best for him for LIFE. Many vets get their "nutrition" information from Hill's and Royal Canin, and just don't know any better.

I'll PM Otto and ask her to help out. She has done EXTENSIVE research on appropriate wet foods for cats with crystal problems.

The problem is the dry food you're feeding your cats, sorry. :anon: Cats are descended from desert animals, and they are designed to get all of the moisture they need from eating a meal - not drinking water. Cats have no thirst drive. And this is the result - concentrated urine. Crystals are normal in urine - but not when it's concentrated. And it's dangerous in males, it can cause a blockage due to the very narrow urethra. The BEST remedy is LOTS AND LOTS of moisture from the diet - keep the urine as dilute as possible.

Three of our male cats had issues with crystals and/or blockages within their first two years with us, when we fed only dry food. We used the prescription food, Hill's c/d, and it did solve the problem. However, over time, we increased the amount of wet c/d we were feeding them, and then our holistic vet gave me a lecture on dry food - and we pulled it, moved the cats to an all wet, grain-free, low carb diet. And no one developed any problems with crystals.

But really, a grain-free, low carb, high protein canned food with a little bit of water added with each meal is the best way to manage this problem. And struvite crystals are pretty easy to control with diet - you just need the pH of his urine to fall. Again, a low-carb (and no grain), high protein diet is the healthiest way to do that.

Here is information from several vets on the issue of diet and crystals:

http://www.catinfo.org/?link=urinarytracthealth

http://birthofanewearth.blogspot.com.au/2012/02/cats-that-eat-dry-food-only-diets-are.html

Look into Vitamin C to make the urine more acidic.  It's saved my cats life. He used to need the RX food and got him off it after a while.  He eats all friskies wet and hasn't had an issue with urinary in years.  He started at a few months and was very very sick a few times.
 

Update: I quarantined Zach overnight to make sure he didn't develop a blockage.  No problems there.  He's obviously still hurting because he talks to himself before going into the litter box.  I finally learned that I could just pry his mouth open and drop the pain pill down his gullet (he's sneaky about spitting pills out, and crushing them is a waste because it wrecks the taste of his food).

He doesn't like the rx wet food (Purina UR).  He doesn't like wet food in general, at all.  I've added water or canned tuna juice. I've tried heating it. He just drinks out all the fluids and leaves the food.  Tonight I sprinkled some kibbles in (grain free, and literally like 8 pieces) and stirred it around  to make it more appetizing and he still didn't eat it.  He wouldn't eat wet food this morning, either - he waited by the door while I fed the other cats (kibble) and when I opened it he darted out and went straight for their bowls.

Now what?  :/  Wait for him to break down and get hungry enough that he'll eat anything?

MrsH said:

Now what? 

Click to expand...

I firmly believe that there is not a cat on this planet that can't eventually be converted to a wet food diet. May not happen today, may even take some months, but it WILL happen, with enough patience and persistence. Here are some links for you to check out to get you psyched up for the process:

http://healthypets.mercola.com/site...nsition-your-cat-to-raw-food-diet-part-1.aspx

http://healthypets.mercola.com/site...nsition-your-cat-to-raw-food-diet-part-2.aspx

http://www.catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_

What happens if you pulverize the kibble into a fine powder and sprinkle that on top of the wet?

Or make balls out of the wet food and roll them in crushed kibble? (Is it pate style?)

But no, you can't starve cats into eating. Doesn't work and can harm them.

I normally hate drys but when my cat was sick dry c/d helped him alot!  maybe a combo of both types of rx for now?
 

If he likes gravy, try adding water to pate canned food until it is the consistency of gravy. Use warm water to make it more palatable. It is imperative that he never have dry food again. Including prescription dry. My Mazy ate prescription c/d for 7 years, because she wouldn't eat the canned c/d. It controlled her struvite, but it destroyed her digestive system, all that corn and junk. She's on a non prescription canned diet now, and I monitor her pH at home with urine pH strips. She hasn't had a check up yet, since I took her off the c/d, that comes next week, so I will find out how accurate are the pH strips I am using.

There are other brands of prescription you can try, CANNED only, if he doesn't like the Purina UR. Of course he does have to eat. As was said, cats often won't "eat when they get hungry enough" and it is very dangerous to try to force them this way. But you can try commercial grain free canned foods too.

Amitriptyline is often used in tough struvite cases, but usually as a last resort, not right off the bat. The first thing of course is to get the pH regulated to a healthy 6.4. And as much water into him as possible to keep that bladder flushed out.

The pain meds are important because pain causes stress, so I'm glad the vet prescribed that. Stress not only causes the pH to whack out, it also can cause inflammation, which causes more pain and more stress. Another reason the amitriptyline is helpful.

All paws crossed for your boy.

PS You'd have better luck with a canned transition if you take all the cats off dry food. With no dry food in the house, he will eventually forget about it.

You guys are great.  I love that people here are so helpful!

It is pate style, but it's a little crumbly.  It's hard to make a gravy with it.  I may be adding too much water when I feed him, because when he drinks it all, it leaves a "sediment" of wet food on the bottom of the bowl (not a mound) so it might be too hard for him to eat it.

This morning I shoved the Tramadol down his mouth and he was very upset.  He wouldn't take a treat afterward (not even a piece of kibble!), and he won't go into the laundry room anymore, which is where he used to eat.  I feel bad that we have 17 more doses of this.  Now he's on his cat tree staring out the window looking kind of spaced out and swaying a little bit.  But I haven't heard him crying in pain this morning, so I guess it's working.  I moved the cat tree from the family room to the study where I spend 80% of my day studying so I can watch him more closely.  I can't tell if he likes this change or if I should have left things alone, because I don't see him sleep much lately - he just sits and looks around, even if the shutters are closed.  Maybe the amitryptilene would be helpful for a few weeks.. I have the pills anyway, and if I'm popping one down, why not add another at the same time. :/

Yesterday I gave him the juice from a can of tuna for some extra fluids. Then I made "tuna cubes" (the tuna meat with 2 cans of water added into food processor, then into an ice cube tray & frozen), and breakfast went like this:

1. half a can of rx wet food

2. one tuna cube heated in the microwave

3. a Cosequin capsule (sprinkled) on top

4. three pieces of kibble on top

I didn't mix it this time, and he ate it all.  Then he scavenged for kibbles.  

Now, some questions:

1. Doing the math, if he gets a tuna cube with each meal, it amounts to 1/7 of a can of tuna each day, or a can a week.  It seems like an excellent and tasty way to sneak in fluids.  Is that going to be detrimental to his health?

2. I read that kibble alkalizes urine pH because of the carbs.  He was on a high protein, grain free regimen before - what else could have caused his urine to be so alkaline?

3. The vet suggested that stress could have caused his problem. He did not seem even remotely stressed.  Do cats internalize their stress?

4. I'm not noncompliant, but I am stubborn (like my cats!).  Can we ever go back to a grain free kibble for him and simply add water/juices to it so he gets the fluid?

THANK YOU for your patience.  

Tuna is not good for cats, especially cats with urinary tract problems. Try canned human chicken instead. Use the kind packed in water with no spices added. He really shouldn't be having the tuna.

I have a struvite girl. I monitor her urine pH. Every time I give her even one or two kibbles (grain free) as a snack, her urine pH jumps to 7.5.

Cats, as obligate carnivores, are designed to get their moisture from their food. They can't ever drink enough to make up for a kibble diet. And a cat prone to urinary tract issues really really really needs to be on a canned diet. Males especially, as the male cat has such a narrow urethra, blockage is a serious problem.

Don't despair, this is all very new to you and him. So he is drinking the gravy you make, with the canned food? This is great! Make sure you mix it really well. Mash the food to help it blend. Keep track of how much you put in each serving so you know how much he is eating.

17 doses of tramadol? How many a day is he getting? When is he going to have his urine retested? I would take the pain meds day to day. He may not need to be on it quite that long. My vet prescribes 2-3 days worth of pain meds for a cat with a UTI.

Is he on an antibiotic? (did they find bacteria in his urine?)

Giving the tramadol and amitriptyline at the same time will sedate him quite a bit. You might want to space them apart some.

Here is a site you might want to have a look at. Dr Lisa is wordy, but there is a lot of good information here. Look to the right for relevant articles

www.catinfo.com

Thanks, Otto.

if I mash the food he won't eat it.  I have to leave it in a chunk that he can bite off, or else he only drinks the liquid and leaves the food.  I  think it just sticks to the bottom of the dish if I mix it, and he cant really scrape it off.  I got the idea for the tuna cubes from the CatInfo website, actually.  I thought about buying canned chicken and using that liquid, but if feline physiology is at all similar to human physiology, I worried that the sodium content would decrease his urine output.

I just re-read the part of your post about gravy. What I was actually doing was adding water to the food and stirring it with a fork, which made a weird sediment.  I'll try using the food processor instead. 

The vet gave me 10 days of tramadol (twice a day dosing), and 20 days of amitriptylene. No antibiotics. She didn't say how long until he should start to feel better, and she didn't say anything about a follow-up appointment for another UA, and the office didn't call the next day to ask how he was doing.  I'm actually pretty disappointed.  The good news is he's peeing fine, and he's not wandering around the house howling anymore - but he still talks to himself before getting in the litter box.

I was so extremely hesitant to move everyone to a wet only diet, but it's looking like we'll have to do that after all.  It just doesn't seem fair to have Zach eat wet food only when he loves dry, and make Merlin eat dry when he really loves wet.

Cat lady drama.

But I think canned tuna may be just as high in sodium as canned chicken. I'm sure you can find low sodium chicken.

Was the advice about tuna for transitioning cats to canned, or for cats with urinary tract problems? Tuna can be high in heavy metals, very bad for any cat, but especially cats with UT problems. If you do use tuna, use dark meat tuna. Albacore are bottom feeders and more likely to carry heavy metals and mercury.

Most vets don't make follow up calls, but I do think it is odd that a follow up appointment was not suggested. Perhaps a new vet is in order.

Don't worry about drama. Many of us are constantly agonizing over one issue with our cats or another. :lol3::lol3: I've got one who will eat anything, one who will eat nothing, and one in between.

Hey at least you've got one cat who will be happy with a canned food transition, right?

Just adding a link - the CatInfo isn't .com, it's http://www.catinfo.org

Specifically, diet and bladder health: http://www.catinfo.org/?link=urinarytracthealth

Thank you all for the advice.  Update:

I fought it for so long, but everyone is on a wet diet now.  All are thrilled.

I did twice-a-day tramadol for Zach x 3 days only.  He is very sensitive and easily upset with forcing pills down his gullet.  We're doing it as needed now. If I hear him crying, I give him a dose, but he hasn't needed one since Thursday night.  I never started the amitryptilene and I don't think I will.  I don't see frequent trips to the litterbox and there haven't been any carpet stains since his trip to the vet.  Overall he is much more relaxed and is sleeping better.  He even jumped into bed with me this morning to cuddle!

I was not given guidance by the vet regarding followup or maintenance.  Our old vet (very pricey) called the day after he was treated for UTI to check on him.  I would switch back but while I'm in anesthesia school, being able to save $20 per vet trip is a big deal for us.  :/

Do we even need to follow up if the problem has resolved?

How long should I keep him on the rx diet?  I have about 36 days worth of Purina UR (24 cans, 2/3 can a day). Should I stick with it another month after that?  We will clearly never go back to dry, but I'd rather not have him on rx for life if I can put him on a commercial food that provides as much water for 1/2 the cost without trips to the vet.

Should I just be asking my vet these questions?  Oof.  

This is what I would do, if it were my kitty. I would have his urine rechecked in a month. If all was normal (normal pH, no bacteria or excess crystals) I would gradually wean him onto your preferred canned food diet, avoiding foods with fish or grains. Read labels carefully because many foods contain fish, even though it isn't in the name of the food.

Three months after he is on a commercial diet, I would have his urine checked again. If all is well, at that point I would (try to) stop worrying.

Congratulations on getting your cats on an all canned diet. You'll love the difference in them.

PS I check my struvite kitty's urine pH at home using these.


Tomorrow is her annual urine check. I will know then if I am getting accurate reading from the strips.