Urinary issues

My cat has had urinary issues for 2 years now.  The vet labeled him as idiopathic.  This year he developed struvite crystals and has been on Hills C/D diet for the last month.  He continued to have straining and a high urinary ph on the Hills so I just switched him to Royal Canin SO.

The crystals might be dissolved by now, but he is known to shed them inconsistently (one day he has them, the next he doesn't). The last urine sample did not show crystals.  He did have an X ray which did not show any bladder stones. He does not have any bacteria in his urine either.

The problem is he still has straining despite the change in diet. When he goes to the litter box he sits there for a few minutes, strains to urinate, nothing comes out, he sits a little longer and only then is he able to go.  (He is passing urine, just having a difficult time going).  He has to stand up to pee. 

He pees in the house almost every day. I have to keep him locked up except when I know he has gone to the bathroom.  I have been clicker training him to use the litter box, which is partially successful (as long as I put him in the litter box 3x a day).  If I don't take him to the litter box he has an accident in the house.

We've tried:

Antibiotics

a home made diet  (3 weeks)

glucosamine daily

prednisolone

meloxicam

Hills Z/D for allergies

Hills c/d for urinary issues

Natures variety LID (which is what I think caused the crystals to begin with)

and most recently Royal Canin SO

So far nothing has really helped. I am at a loss.  I want to keep him on the SO diet for the next month. If this doesn't help I'm thinking of asking the vet if they can do surgery. He looks so uncomfortable when he goes to urinate.  I could try him on Pentosan injections, but not sure they would be any more effective than the glucosamine.

Does-he-seem-to-try-and-pee,more-than-normal,or-more-than-he-usually-does,does-it-seem-like-he-tries-to-pee-alot-during-the-day?

If-so,he-may-have-a-bladder-infection.If-ya-ever-had-one,its-real-painful,and-it-feels-like-you-have-to-go-all-the-time,even-tho-you-don't,and-when-you-pee,it-burns-real-bad.

Have-they-done-a-"clean-catch"-which-means-they-insert-a-needle-into-the-bladder,and-draw-out-some-urine.Have-they-done-a-urinealasys?

The-others-can-help-me-out-here,LOL,there-is-a-3-day-one-and-there-is-a-5-day-one,and-the-5-day-one,is-better.They-can-better-explain,how-it-works.

If-they-are-sure,he-does-not-have-crystals,then-he-is-not-blocked.One-way-you-can-tell,is-feel,somewhere-between-their-tummy-and-inbetween-their-back-legs,that-is-about-where-their-bladder-is.If-you-feel,what-feels-like-a-golf-ball-sized-lump,for-lack-of-a-better-word,then-the-kitty-is-blocked,and-cannot-pee.If-that-is-the-case,you-have-12-hours-to-get-them-to-a-vet,or-its-too-late.

I-have-a-crystal-kitty,and-his-happened-late-on-a-Sat-night,he-was-rushed-to-the-ER,so-I-did-extensive-research-on-crystals-and-urinary-issues,and-my-vet-told-me-alot.His-happened-when-he-was-2-yrs-old,he-is-9-yrs-old,and-no-more-issues.

What-do-you-feed,wet-or-dry?

Crystal-kitties-"have"-to-be-fed-wet,you-"have"-to-keep-them-flushed-out,it-is-imperative,thats,what-lowers-the-urine-ph,is-you-are-diluting-the-urine.You-have-to-mix-the-wet,with-water,so-its-like-a-soup.

If-your-feeding-dry,thats-why-the-urine-ph-is-so-high,he-is-not-getting-enough-water,and-they-don't-drink-enough-water,on-their-own,to-dilute-it,and-keep-them-flushed-out.

Grains-are-also-a-huge-cause-of-crystals-and-urinary-issues,which,Hills-and-Royal-Canin,yes-even-SO,are-full-of,look-at-the-ingredients-on-the-bag.

At-2-he-was-put-on-Hills-SD-to-disolve-the-crystals,then-CD-to-maintain,the-crystals-came-back,at-a-show,no-less,and-I-said,something-ain't-right-with-this-picture,different-vet-at-the-time,so-I-did-alot-of-research.

No-tap-water,its-full-of-minerals,some-use-Brita,some-use-PURR,some-use-only-purified-drinking-water,not-spring-water,but-purified.I-buy-the-store-brand,its-$1.00-for-a-gallon-jug.

No-fish-anything,no-foodies,no-treaties,no-tuna-fish-or-tuna-fish-juice.That-is-another-cause,and-you-have-to-avoid-fish-anything.

Stress-in-the-household,is-another-biggie,what-is-it-like-in-your-household?

Other-pets-in-the-household?

They-associate-the-pain,with-the-cat-box,thats-why-they-stop-using-it,or-use-it-sometimes-and-not-other-times.

Do-you-pick-the-box-every-day?

What-kind-of-litter-do-you-use?

Have-you-changed-it

Is-the-cat-box-hooded?

How-big-is-the-box?

Where-is-it-located?

Have-you-moved-it?

You-said-you-now-feed-RC,you-used-to-feed-Hills,what-did-you-feed-before-that,you-said-the-issue-has-been-going-on-for-2-yrs-now.

I feel compelled to repond to your thread because my cat Clark has had ideopathic cystitis for many (6+) years.  I don't know that I can offer much concrete advice, because my cat continues to have his problems, but we keep trying new things, and he is still going strong.  It's been a process in treating him.  When he first blocked, the vet said he basically had a weak bladder wall.  All subsequent vets believe the same thing.  He's not physically capable of fully emptying his bladder, so it gets irritated and inflamed. 

I can't remember a time when he didn't have to hunker down for several minutes before urine would pass.  In a normal day, he pees close to 30 times a day.  If he's about to block, it's twice that. There has never been an infection, there rarely has been crystals, mostly it's blood and inflammation.  Two years ago when he blocked, they did an ultrasound and found either inflammation or cancer starting to build at the base of his bladder.  He now has several masses in his bladder which they believe are cancerous, although the piece they biopsied only found inflammation, not cancer.   He had a stent inserted in his urethra a few months ago, pushing the inflammation aside at the junction to the bladder (kind of like angioplasty and artery plaque). 

There are many good sites out there to google and at this point you've probably read them all.  I'll try not to preach to you. 

Looking at the list of things you've tried, I'll mention diet first.  I've never tried any of the special vet foods, we stopped all dry food after he blocked the first time and have gradually gone from wet only, to grain-free wet, to no fish grain-free wet, to raw.  Carbs are known to cause inflammation in a cat, whether those carbs are in a dry or wet diet.  I know vets suggest the SO diet, it is suppose to deal with the acidity of the bladder and dissolve the crystals, but it is full of carbs.  Rice, corn, even peas (in the LID)...are just not good.  Fish is known to be allergenic to cats, so can also cause inflammation in the bladder.  Ironically, the fish oil with Omega-3 is supposed to help fight inflammation.  So, after you are comfortable that there are no crystals, I'd suggest you try to switch your cat to a high meat, no-grain, low-carb, fish-free wet food.  You can look at catinfo.org for her list of commerical foods to see what might fit.  This is why I finally switched to a raw diet, nothing seemed to "fit" as well.  The acidity level of his pee is perfect.  I use Phinex pH test strips that I buy from Amazon to keep it in check. 

Generally when they pee outside of the box, they are trying to find a place to pee that isn't associated with pain.  When Clark gets really bad, he seems to appreciate it when I spread the boxes out into other rooms.  Somehow peeing in the box in a different room works better - he always heads there when he's having trouble. 

I keep Buprenex and Phenoxybenzamine on hand so I don't have to wait to see the vet if he starts having problems.  The Phenoxy is an anti-spasmodic which helps control the urethra and contract the bladder.  I've read some very technical briefs discussing the use of anti-spasmodics for this situation, there are lots of options (different meds), this one seems to work well for Clark.  The Buprenex is for pain.  At the oncologist's suggestion, we tried Tramadol for pain (cheaper than Buprenex) and Clark had a terrible reaction to it.  We're sticking with Buprenex.  Fortunately, we haven't had to use either for two months now. 

What I would suggest is you have your cat get an ultrasound of the bladder, to check to see if there are visible problems.  I know you said he had an xray, I'm not sure that would identify inflammation build-up.  I could be wrong so you might ask your vet if the xray is complete enough.  When Clark's inflammation was first noticed, he started taking Piroxicam (as opposed to Meloxicam), an anti-inflammatory that works well against bladder inflammation.  His quality of life was severely affected, so we stopped.  Now, a few years later, he's taking Onsior, a newer anti-inflammatory.  There aren't any studies that say it specifically helps bladder inflammation, but he tolerates it fairly well, and he's still peeing. 

Some say glucosomine works, some say it doesn't.  I say it can't hurt.  I give Clark slippery elm diluted with water on a regular basis with his evening meal, which provides a mucus to the whole GI and bladder tract.  I talked to his oncologist about curcumin.  He was aware of it's anti-inflammatory capabilities, but wasn't sure he wanted to combine it with Clark's other meds.  He did suggest the Omega 3's, which I add to his food.  I also give him probiotics and digestive enzymes, trying to keep his digestive system working and reduce any inflammation coming from that source. 

The PU surgery certainly serves its purpose when blockage is at the end of the penis.  Before taking that step, I'd make sure that is where the blockage is and not further up the pipeline. 

I don't mean to write a book, so I better stop.  I wish you both the best.  I'll share more if I think of something else.  Hang tough!

@LCat4  I was wondering how is Clark doing?

Hi Susan,  Thanks for asking.  Clark's not doing as well as he was back in July, but he's hanging in there.  He had a bad September; he started not eating his meals and he lost a bit of weight.  I took him to the oncologist and his blood test revealed a big spike in his kidney values.  This was always the concern because we were trying to minimize his bladder cancer growth with non-steroidal anti-inflammatory meds, which are known to be hard on the kidneys.  The doctors stopped the NSAID and gave him antibiotics, hoping it was an infection that caused the spike.  His values increased.  We stopped the antibiotics and introduced sub-q fluids (100 ml, every other day). Although this has made him more comfortable, his kidney values are still high.  Last check in early December showed his creatinine was at 5.0 and BUN in the upper 70's.

In October, I modifed his diet with the gracious help of Mschauer.  He's now eating an all home-cooked food that is low in phosphorus and calcium, with no carbs. Although, at this 4th stage of CRF, it is often recommended that a cat start eating the kidney prescription food because the food is lower in phosphorus and protein, that food is also higher in carbs and potassium. Clark's cancer precludes a diet with carbs, and for some reason, Clark's potassium level was beyond high normal. By giving him certain meats with higher fat content, lowering his liver consumption, and adding supplements with eggshell calcium, we are able to meet his caloric and nutrition needs. Our vet approved his new diet and he is back to eating and has gained back the lost weight. Sometimes his 3 meals a day are consumed over 5-6 meals a day, but he's finishing it at some point.

Although I can tell he's not feeling as well as he once was, he still grooms his brother, hops up on the kitchen counters, and seeks attention for lots of love.  When being chased by our youngest cat, he is amazingly spry and agile.  His current preferred spot to sleep at night is on my pillow, with his chin resting on my forehead.  It's not necessarily the best spot for my sleep, but he is quite comfortable.

I'm not quite sure what's ahead for him.  We will continue to check his blood values every couple months, to see if there are needed modifications to his food.  We have stopped all meds that relate to the cancer, but he continues to get fluids every other day to help flush everything out.  Thankfully, although he pees about 30 times a day, he still continues to pee, which means the urethra is not yet blocked by the masses.  He is well loved and well watched for his quality of life.

I don't mean to snatch the thread away from Sarah Ann.  If she is checking in to this thread, I hope her cat is feeling better!

Thanks again for asking.

Sorry Sarah Ann! I didn't even think when I posted the above. Unintentional hijack.  I remember your post from a couple of months ago that your boy Pounce was doing much better.

I hope that's still the case. 

Both you and LCat4 are amazing juggling all of the dietary and medication tweaks and tricks. 

I am sorry that Clark has declined. Considering all of the difficulties he's had, he must be a pretty spectacular guy. His caretaker ain't half bad, either!   Eating, grooming, playing, and keeping your forehead warm; sounds like he's at least happy and fairly comfortable, but I'm sure it's a daily battle for both of you. Best wishes.