Spooky's crystals/cystitis - back at the vet

I never actually started a thread about this, but have posted about her situation in others' threads. :anon:

Over the course of her 10 years, Spooky has had bouts of cystitis. Her symptom was always peeing outside the box. We also discovered that she would pee outside of the box when her teeth hurt (she has bad genes for teeth, and has had five removed over her life).

So... January of 2012 we switch to a raw diet. In March or April, Spooky is clearly having bladder distress. An ultrasound reveals 3 stones, that have probably been there for some time. We don't know whether they're calcium oxalate or struvite, there were no crystals in her pee, and no bacterial infection. Normally, they'd recommend surgery to remove the stones, but as she's on an acidifying diet, if they're struvite, they should dissolve. We put her on pain meds and sub-q fluids, and I start keeping track of her urine pH.

The good news? The diet DID dissolve the stones. They were struvite (calcium oxalate stones cannot be dissolved, they can only be surgically removed).

The bad news? She had residual "sludge" in her bladder. There was no longer any inflammation of the bladder wall, but the very existence of the sludge raises the urine pH, and the cycle of struvite crystal production continues.

So we add 1,500mg of methionine to her diet, 500mg at each meal. (Methionine is the same urine acidifier used by many foods, notably Hill's in their c/d prescription food for bladder health).

I keep track of her urine pH. It's always good for a while, and then starts to creep up, to 7.0 or 7.5.

So we have now done... 3? 4? 5? rounds of sub-q fluids. This last round we gave her 100ml every day for 10 days, then every-other-day for about a month (we're still doing them, the latest bag isn't finished).

Two weeks ago? Her urine pH is back up to 7.5!!!!!!!!!!!!!!!!!!!!!!

It can't be her diet. Unless, somehow, she's uber sensitive to the phosphorus and magnesium in the bone in the ground meals she gets (I don't otherwise give her bone-in meals, I use an alternative calcium supplement, eggshell powder, which has almost no phosphorus, and lower magnesium levels). So I order a calming collar and ramp back up her L-theanine (also helps calm a stressed kitty). Spooky IS very highly strung.

So anyway... I was a bad meowmy, and skipped fluids when she was due on Thursday.

And last night, she was in and out of the box, trying to pee. Our poor baby girl!!!! :rub: I gave her fluids, and calmed her down.

So she's at the vet, waiting for an ultrasound that may not happen. The vet that does the ultrasounds was coming in to do one for an emergency case. If he has time, he'll do the US for Spooky today. Her bladder, thankfully, is full. Whether or not she gets the US done, they'll pull ANOTHER sterile sample, and we'll do the urinalysis and urine culture again....

At this point, though we want test results to see what's up with her urine or potentially infection, and ultrasound results to see if her bladder wall is inflamed or what's in there.... the vet is thinking the next step is to order D-mannose and give it a shot. (Even when urine cultures test negative, the bacteria can be embedded in the bladder wall, and D-mannose will kill this). My vet was diagnosed with "cystitis," and there is no cure, and they don't know what causes it. But she takes a cranberry extract supplement daily (D-mannose is a sugar from cranberries that kills E. coli and ... forgot the other type of bacteria), and that stopped the problem. When she doesn't take it, it comes back. Cranberry extract itself is toxic to cats, but the D-mannose isn't.

Long post, and if you made it all the way through... But it was a year of catch up.

We'll try corn silk if her bladder wall is inflamed. Other than that.... we're running out of ideas. We may have to consider amitriptyline again. :dk: We'll see. But we'd really appreciate some vibes for Spook.

...it's amazing how slowly time moves when you've got a kitty at the vet, and we're at home waiting.....

Geez I'm sorry. Wish there was a way to wash that sludge out!

Sending many good vibes your way!

Gosh, poor lil Spooky .  Hoping the ultra sound can be done today and the issue can be determined.

Poor Spooky and Laurie, poor you too, sweetie. :rub: I have heard of D-Mannose as my SIL does a lot of research on chronic cystitis in her Havanese dog. She told me just recently about it for possibly Pip. And, yeah, the amitriptyline might be in order for short term again. Short term use can be so beneficial so the bladder can take a rest. BUT - first thing first.... for Spooky at the vet today. Gigantic hugs to you and Gary too. Will be waiting to hear a report when you can. :grphug: :grphug2:

Poor Spooky. Sending lots of vibes her way.

Thanks for the vibes for Spook!

She did get the ultrasound!

The GREAT news? The sludge is GONE! All those sub-q fluids FINALLY did the job!

The good news? Her bladder wall shows "Very, very slight inflammation."

The bad news? Why she was in and out of the box last night is a COMPLETE mystery. The inflammation is so slight, that the vet would normally say there's nothing going on. There's no apparent medical reason for her discomfort.

We won't have test results back for the urinalysis until Monday, they took a sterile sample and sent it out. The urine culture won't be back until later in the week.

The vet sees no reason to change her diet, period. Can't imagine how it would help. If her pH is over 6.5, it's not diet induced.

Spook's issue is looking more and more like it's stress, but we'll know for sure when we have test results back.

She wants me to go ahead with the D-mannose. We'll consider the amitriptyline after we get tests back.....

Hooray that the sludge is gone! Sending calming stress-free vibes for Spooky

WELL!!! This is great news that all of that yukky sludge is gone!! Still, I know you are worrying and wanting a more definitive answer. If it is stress, then at least we know that the Elavil will do it's job and usually it does not have to be a permanent medication. It seems to work for Pip during times of stress - two months on and then a few off. Let's just wait and see what the urinalysis shows and that culture as well. But, what grand news about that ultrasound!!!!! In the meantime, monster hugs to you!!! :heart3: and loads of kisses and scritches to sweet Spooky. :rub: :rub:

Awww... poor Spooky... you too. At least the sludge is gone. THAT is good news Sending vibes and I know you'll keep us posted

Hi Laurie, Monday was the day you were to hear about the results of the urine culture? Any news?

Congratulations on getting her bladder sludge free, anyway. How is Spooky feeling these days?

For some weird reason, the results weren't in on Monday. :dk: We called Tuesday, and got a message from the vet yesterday mid-day. Her urine pH was 7.0 (!! ?? !!) and there were NO crystals of any kind in there. So again - mixed news. :lol3: But VERY glad there are no crystals!

The culture results should be back by the end of the week. But the 24 hour mark showed no growth. The comments were that her urine is "very" clear. I don't remember the urine specific gravity, but it was good. Vet believes the culture will be negative, and what we're looking at here is stress-based cystitis.

I'm giving her the D-mannose for a few days as part of the "covering the bases" thing. I've ordered corn silk, and I have Cosequin here that I'd ordered for Flowerbelle, but never used, because it turns out to be contra-indicated for her because of her high blood pressure and asthma.

So I've added Cosequin, and will include the corn silk when it arrives.

I also ordered and received Rx Vitamins NutriCalm: http://www.thehealthyelement.com/pr...gclid=CPjzm-2Y2bUCFUZV4AodA24Acg#.US9nA1fvY7s I haven't given it to her yet, she didn't show up for breakfast this morning. (She skips meals every once in a while). As it has theanine in it, I'll stop giving that to her.

I'm not going to go cold turkey on the fluids, I'm giving them to her every 3rd day now, and will probably give them to her weekly on an ongoing basis. :dk: Spook LOVES the alone time being brushed, so I'll continue that daily, with or without fluids. :rub: I'll discuss what to do about the fluids with the vet when she calls with the results of the culture.

As soon as I gave Spooky the fluids that evening she was in and out of the box, the behavior stopped, and she's seemed fine since then. But the visit to the vet has given us information we didn't have. Hopefully we'll figure out the right combo to KEEP her comfortable and prevent those crystals from forming. :cross:

OK. Took four days to culture it, but there was "very, very light" staph bacteria in her urine. Normally, the vet wouldn't recommend treating it. If it were her cat, she wouldn't. But given she's had these ongoing issues with her bladder, she's recommending an antibiotic, Zeniquin. So that's what we'll be doing. Of course, the issues are still most likely stress-related.

Since stress is thought to be the main culprit, it's easy to see how stress can lower her body's resistance to fighting that little bit of bacteria. I'm glad it was found and she will be taking the antibiotic. I hope this clears things up and all the other things you are doing pull together to keep Spooky from having any more of these scary episodes.

Such a good point, otto, about the connection between stress and the immune system. :nod: Thanks - I hope we're able to figure out how to help her. We know 8 cats in this space is too many - we knew it when we rescued Chum. Why it's bothering her almost three years later... :dk: Of course, she's always been highly strung. And perhaps it's her physical discomfort making her cranky. I could go around in circles forever. :lol3:

You could, and you most likely will :lol3:

Well like I always say to people who insist their cats who are having some problem or other "have no stress", you just never know what may cause stress, from a cat's point of view. The fact is, some cats are more prone to environmental (known or unknown) stress than others, and there is often no predicting or discerning what the stress factor is, but there is the cat...sick or reacting in some other negative way...from stress.

I know you are already aware of that bit of knowledge, but I think it bears repeating for anyone else reading, who might not realize.


Spooky :heart3:

Aw hun, the ups/downs and spinning around and around :spin: we do to try to figure out our complex feline creatures! :lol3: Dr. Mark also told me that since Pip is a VERY VERY high strung kitty that bacteria can take hold due to stress. I really do not think that your having the 8 kitties in your RV is causing Spook's issues. Didn't she have urinary issues when you first brought her in years back too? I think sometimes it is how these kitties are "wired" just like some people, like me!!! What might not stress out one kitty could completely uproot another. COMPLEX CREATURES!!!!! I am telling you, all of your cats could not have a better life with you and Gary in your lovely RV. Much better than a lot of other cats who might live in mansions. AND, cats love routines/schedules and TOO much space can even be more stressful than not enough, IMO. Nope, hun, , I think it all boils down to their innate personalities and temperaments and that in itself can possibly cause a multitude of stress related health probs. (so I am learning, Pip is a good teacher of this. )

I am SOOOO thrilled, though, that all of her tests are clear other than the slight bacteria in the culture. I have heard of Marbofloxacin !!! From Dr. Mark!! He said a few months back after we tested Pip's urine again that Zeniquin would be the one to try this time. He explained it is effective against both the gram negative and gram positive bacteria. I think you have a darn good vet and I do miss my Dr. Mark but he is always available for phone calls.

for Spooky and :grphug: :grphug2: for you!!!!! :sun:

I-have-a-crystal-kitty-and-my-female-who-had-a-UTI-when-she-was-2,it-seems-to-be-resurfacing,so-I-understand-the-frustration-of-an-ongoing-issue.

What-I-have-found-out,thru-extensive-research,and-my-own-treatment,it-is-imperative,to-keep-them-flushed-out,beyond,imperative.It-lowers-the-urine-ph,dilutes-it,which-in-turn,keeps-the-bladder-walls-from-becoming-inflammed,and-keeps-the-crystals-flushed-out.

I-don't-know-anything-about-raw,so-I-can't-tell-you,if-what-your-feeding,is-a-contributing-cause.I-do-know,that-diet-is-the-biggest-cause,those-that-feed-dry,those-that-feed-grain-foods.I-know-you-don't,but-I-don't-know-if-the-ingredients-you-do-feed,may-be-part-of-the-cause.

My-crystal-kitty,has,to-have-wet-only,mixed-with-water,so-its-real-soupy,twice-a-day.I-tried-going-back-to-wet-once-a-day,and-dry-at-night,his-issues-came-back.My-vet-said,he-has-to-have-the-wet,with-the-water,to-keep-him-flushed-out.Now-no-more-issues.

My-female-was-getting-wet-in-the-morning,mixed-with-water,so-its-real-soupy,and-dry-at-night,mixed-with-a-little-water,too-much-water-in-her-dry,she-either-won't-eat-it,or-she-throws-it-up.She-was-crying-in-the-cat-box,put-her-on-wet,with-the-water,twice-a-day,no-dry,and-the-issues-went-away.Tried-going-back-to-the-dry,back-to-crying.Put-her-back-on-the-wet,with-water,no-more-dry.Now-no-more-issues.

The-key,is-to-get-the-alot-extra-water-into-them,to-keep-them-flushed-out.Both-my-issues-went-away.Just-from-reading-the-thread,its-seems-when-you-give-her-the-sub-q-fluids,it-goes-away,so-that-tells-me,thats-the-key-to-helping-her,the-extra-fluids.

Another-thing-to,with-these-kitties,is-you-cannot-give-them-tap-water,it-has-too-many-minerals-in-it.They-have-to-be-given-purified-drinking-water.Not-spring-water,not-distilled-water,but-purified-drinking-water.I-get-the-store-brand-jug,its-$1.00.Or-some-use-Brita,some-use-PURR.

You-have-to-be-real-careful-of-giving-them-acidifiers.If-you-do-this,you-also-have-to-factor-in,what-your-feeding,as-that-throws-it-off,changes-the-composistion,per-say,of-the-acidifier,as-to-what-value-they-are-actually-getting.

If-all-else-fails,I-have-a-very-good-friend,on-another-board,that-went-thru-all-this,nothing-worked,tried-everything,vet-didn't-know-what-else-to-do,even-discussed-maybe-putting-him-down.I-badgered-the-crapola-out-of-her,to-see-a-specialst,one-that-specialises-in-urine-issues.She-went-to-a-few,same-results.She-was-actually-thinking,of-putting-him-down.

In-Texas,we-have-the-stand-and-fight-mentality,the-Alamo,and-such.We-stand-and-fight,we-don't-back-down,and-we-don't-take-"I-don't-know"-for-an-anser.Well,after-more-badgering,to-the-point,she-was-getting-"pissed-off"-at-me,she-tried-one-more.I-told-her,he-cannot-speak,he-cannot-take-his-own-self-to-the-vetty,you-have-to-do-it-for-him,you-are-his-voice,you-are-his-mommy,you......have-to-stand-and-fight,for-him.

Well,this-specialist-said,I-know,exactly,what-is-wrong,with-him,and-I-know,exactly-how-to-fix-it.She-did,and-now-he-has-no-more-issues.

He-is-the-most-beautiful-Norweigan,I-ever-saw,such-a-very-sweet-boy.I-would-have-cried,if-she-just-gave-up.I-told-her,don't-make-me-come-up-there,and-take-him,myself,she-knows,I-would,lol.

The-specialist,she-saw,was-in-the-Buffalo,NY-area.Not-that-far-from-NJ,and-at-the-very-least,your-vet-can-talk-to-her.If-your-interested,paw-mail-me,and-I-will-get-you-her-contact-info.She-can-tell-what-the-vet-found,and-give-you-the-specialists-name-and-number.

(((((((((((((((BIG-HUGS)))))))))))))

Thanks, Flint, I appreciate you taking the time to share all of that!

To ease concern, the urine acidifier is being used under direction of the vet, and I test her urine pH at home. We know the diet she's eating is low phosphorus and low magnesium and very high in moisture.

Her problem is somewhat unique, in that currently it is not her diet causing crystal formation. Her latest urine was crystal-free. We transitioned to raw in January of 2012, and as it turns out, going INTO it she had three struvite stones in her bladder. We didn't know they were struvite, but the vet, who would normally recommend surgical removal, recommended that we see if the raw diet would dissolve the stones, being naturally acidifying.

It did.

But there was some "residual sludge" left in her bladder, thus all the sub-q fluids. The very existence of the struvite sludge raises urine pH, thus the combination of aggressive fluids and a urine acidifier resolved that problem.

The current issue is that

- the sludge is gone
- she is no longer creating crystals
- but her urine pH remains at 7.0 (last night it was 6.75) even with the acidifier. The theory now is that because she's highly strung and prone to stress easily, her stress is causing the urine pH issues. We will continue to monitor her urine pH and adjust the acidifier as per vet instruction.
- last Friday's urine culture DID turn up a "light" staph infection. Don't know if it's some kind of chronic thing, even though the culture 3 months ago turned up nothing, or if we simply caught this early.

So right now treatment will revolve around treating the staph infection with antibiotics, and figuring out how best to manage her stress. The vet feels her diet does not need to be adjusted.

I will likely continue to provide her sub-q fluids on an intermittent, but regular basis. She really enjoys it, so no reason not to do it.

To manage her stress, we are going to try

A calming concoction that contains theanine, valerian, and ashwagandha
We'll see if a thundershirt helps her

We also have Feliway plugged in, Bach's Rescue Remedy, a (pheremone) calming collar - but we'll try one thing at a time, rotate to evaluate, and then "pulse" treatments that include bladder soothing remedies such as corn silk and Cosequin.

...at least that's the current plan.

OK. VERY, very interesting news to report.

Spooky had another freak out this morning - in and out of boxes, squatting everywhere. But interestingly, it started with her trying to poop. She's constipated. I suspect this is what happened earlier (given almost no inflammation of her bladder, neutral urine pH, and no crystals at all). I guess she incorporates trying to pee .... out of frustration at being unable to pass stool? :dk: But today clearly the problem was constipation.

So given this has happened so often on the raw diet, apart from needing to address her stress issues, I have to figure out how best to manage her constipation issue long term.

She did have a bowel movement this morning in the middle of this freak out (so I guess there's more to go?). And it was not hard or dry, and does not look like it "should" have been difficult to pass. :dk: I've been really attentive to her calcium levels since this last happened, and basically took her down to a Ca ratio of 1.0:1, and I won't go any lower. And given her stool was normal sized and moist, but not pasty or anything, I don't think she needs a stool softener like miralax (which would be my preference to use), but a little bit of fiber, like pumpkin. :dk: She really doesn't like pumpkin, so I'm thinking rather than a larger amount 2 - 3x a week, I'm leaning towards 1/2 a teaspoon or so once a day.

I should probably start a new thread for some input....

Oh, constipation! That makes perfect sense. But it may not be a calcium ratio issue at all, there are other causes for constipation. Motility, weakened muscles, megacolon, age, kidney disease, not enough exercise..to name a few. I know you are on top of things as far as her blood work, and I am positive she gets enough exercise, but the motility issue...is there even a way to test for that?

An x ray of the colon could help determine the state of her colon, anyway.

I think, for pumpkin to be effective with constipation, a cat needs about a tablespoon of pumpkin a day. Tough to get into a cat who hates it, but it might depend on what kind of pumpkin you have tried, also.

If you are going to try pumpkin, I recommend Farmer's Market organic. Jennie, who has struggled with constipation since she's been with me, shows a definite preference for the Farmer's Market pumpkin, when I switched to it originally because they use BPA free cans. She gets half a tablespoon in a breakfast meal mixed into a soup with warm water, and half in an evening meal prepared the same way, but she would eat it straight, that one. :lol3:

When I was trying to get Mazy eating pumpkin, I did manage to get her eating it, very small amounts in every serving, totaling one tablespoon a day. But she hated it so much, I just couldn't stand to give it to her any more. It just didn't seem fair that she had to force herself to eat.

Diet change helped Mazy, anyway, but Jennie still needs the pumpkin.

But for Spooky if she really really hates the pumpkin..how about increasing the SEB? Or the egg yolk lecithin? Or both?