Urinary SO - Struvite Crystals

oneandahalfcats

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Hi everybody .. I guess its my turn to be in need of some feedback. :)

Recently I obtained a urine sample for Thomas as I have been wanting to get both routine urinalysis and blood work done for him just to have an overall picture of his health, since taking him in as a stray almost two years ago. Recently as I have watched him pee sometimes, his output has looked a bit frothy and maybe a bit too light colored? He pees once a day, sometimes twice, like Max, no hesitation, no straining, flow is good. Everything seems fine.

I got the sample readily from Thomas on Saturday morning, and could see right away that it was a nice golden yellow color, and so looked plenty concentrated. Anyway, I took the sample in as planned, to check it for other things. Specific gravity, protein, leukocyte were within the range, no sugar or negligible protein, BUT, there were some WBC and struvite crystals. Dammit. I looked under the microscope at the clinic and saw first-hand, the struvite crystals. Thomas' PH was 7.0.

Needless to say I am glad I did this, when I did. Thomas is not blocked, does not appear to be in any discomfort and does not appear to be having ANY problems peeing. He seems normal and healthy in every respect.

So, to the point of this thread ... The vet that oversaw the testing, was not my regular holistic vet, but another lady vet who is new, quite nice and seems knowledgeable. I expected on account of the WBC to be given some antibiotics to take home, but instead she suggested anti-inflammatories (ONSIOR) on the chance that there is inflammation due to the presence of crystals. She also recommended to feed Thomas RC Urinary SO for two weeks to see if this can dissolve the crystals. Onsior apparently is a new NSAID and similar to Metacam in terms of effect, but perhaps more effective in zeroing in on the inflammation, than Metacam. I don't use Metacam at all, which is why I asked for and was given something else. 

While I am willing to give the S/O a try, I have my doubts as RC foods in general contain grains like corn. The ingredients here in the wet are somewhat better but still contain corn flour. I asked just what in the SO is responsible for dissolving crystals, and no one could give me a definitive answer besides, it just works? I have read that the S/O formula was actually changed awhile back and some ingredients such as DL-methionine, were removed? I have read up on DL-Methionine and know it to be an acidifier that is used sometimes in this situation, with very careful doses I might add. So how is S/O more effective than just feeding a diet of high protein wet, in other words meat, which should be plenty acidifying?  

The current diet that all of my cats have been getting is a good quality, low phosphorus, wet canned food, with a bit of kibble in the afternoon. The majority of the diet is wet, canned. Plenty of water available. I have had Max's urine tested in the past and his urine has always tested clear?

All responses are welcome, but in particular it would be good to hear from others who have used S/O recently, with good results to deal with struvite crystals, what the causes of crystals were in their cats, other treatments used. Were anti-inflammatories prescribed? I am thinking at this point, that the reason Thomas has developed crystals is that he could be predisposed to them, where Max and Maggie are not, or that as the result of the introduction of more wet, that Thomas may be drinking a lot less water, and may not be getting enough from the wet. I have also read that retention of urine can be a factor.
 
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mschauer

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My Jeta was prone to struvite crystals. This was years ago. There were 2 prescription urinary foods the vet suggested, Hill's S/D and Purinea UR. The S/D was for short term use to quickly dissolve the crystals and the UR was supposed to be fed for life there after to prevent them from forming again. Her urine did not indicate the presence of an infection so she was not given any additional medication.

Urinary foods intended for long term feeding are formulated such that the urine pH will be low enough to prevent the crystals from forming.  The addition of DL-methionine isn't the only way to accomplish this. Grains, particularly corn, also lower urine pH. Also increasing the cats water intake and so increasing urine volume can help keep the crystals from coalescing so some foods contain added salt to stimulate thirst.

Some people have found regular, non-prescription foods that will prevent the crystals from forming. I wasn't comfortable with that approach because I knew pet food manufacturers frequently change their formulations without notice so a food that works one day may well stop working. I had already been thinking about switching to a raw diet and this was the catalyze for me to finally make the switch. I used the S/D long enough for the crystals to be dissolved, as verified by my vet, but I never fed the S/D  UR. Jeta accepted raw food immediately so that is what I fed her from then on. In 6 years she has never had a recurrence of the crystals.

It's very rare for the prescription urinary foods to not work for preventing the formation of struvite crystals. I'm sure you will find the SO works well for Thomas.
 
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denice

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I know from what I have seen here some kitties need either the prescription diet or a raw diet to keep their kitties pH where it is supposed to be.  I have seen people trying to switch to a premium quality canned diet while checking the kitties pH and the pH would start to rise.  They would go back to the prescription diet and the pH would come back down.  I know you are feeding the Nature's Variety canned so your kitty may well fall into that category. 

I think a genetic predisposition is part of this.  We have all heard of male kitties eating cheap kibble and living well into their teens with no issues.  I think that's why it is easier to control in some kitties than in others.
 
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oneandahalfcats

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Thank you both for your responses. I have not read that about corn, but it makes some sense as corn is acidifying. I have read studies about what corn does to cows and we know that it is not a species appropriate ingredient for cats for a variety of reasons, and so this is the concern in using the S/O or other Rx foods for this purpose.

We have already started the SO and hopefully it will take care of the struvite crystals. I will also be adding water to the wet each day. We will do another urinalysis in a couple of weeks time to see where we are at. Also going to get Max and Maggie done as well to see where they are at.

I have tried all cats on raw and it was well received for the most part. Maggie didn't relish it as much but she's finicky about most foods anyway.
Thomas may be a good candidate for raw - He caught and killed two voles this winter. Didn't eat them however, or maybe I interrupted something when I found them? Not that I really want to encourage this.

Just to add another dimension here, I would like to know what people's experiences have been with Onsior, as an NSAID.

Thanks!

EDIT: I think you have hit on a valid point Denice in that dry food may not be the best, but one thing it CAN do is promote more water drinking in some cats which can keep crystals at bay. It will be good to see what Max's urine is like, which has always been good. 
 
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abbyntim

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I am sorry to hear that you're dealing with this. As you know from reading and commenting on my own threads, I am watching Tim for possible struvite crystals in addition to his other issues. For reasons I'll explain below, we chose to not go with a specific urinary tract diet and instead are monitoring closely and will seek medical attention if there are any changes.

I have experience with Hill's Prescription Diet C/D with cats we owned previously. It definitely worked to keep crystals from forming. And all cats ended up eating it because it was too difficult to feed them different foods. I tried to feed the canned version, which they rejected, so I fed these poor cats dry C/D for the majority of their lives. I wasn't savvy about transitioning and received no guidance from the vet (same one we are still with today, not the holistic vet). We lost most of them to kidney failure, and some were quite young. If I knew then what I know now ... I know you are aware of the concerns with long-term use of these foods. If Tim presented with serious crystals after everything we've done, I would definitely consider short-term use of S/D. I don't know what I would do long-term and I hope I don't have to worry about that.

By way of history, Tim has had many rounds of blood and urine tests. One in late January indicated the presence of some struvite crystals. I was shocked as I had transitioned him to an all-wet diet after two serious constipation episodes and he'd never had crystals when on the dry diet. After reading the entire catinfo.org site, I eliminated all fish from his diet; he had been eating Wellness chicken and herring or turkey and salmon every day for his evening meal. A little over a week later, after a weekend of vomiting after every meal, we ended up at the emergency vet, where a urinalysis there showed no crystals but a urine pH of 7.0 (he was alternating Wellness turkey and chicken at the time, with a small amount of Tiki Cat chicken as a supplement). As Tim's urine pH had been 6.0 on two previous visits to the emergency vet (on his dry diet), I was still mildly concerned.

According to catinfo.org, and this is where I am trying to not worry too much right now: "A small amount of crystals is not an abnormal finding in cat urine and the cat should not be automatically put on a prescription diet such as Hill's Prescription c/d, etc. " Additionally, both Dr. Pierson and my holistic vet are of the opinion that moisture in the diet is the bigger concern than urinary pH. Finally, Dr. Pierson addresses some problems with home-catch samples (yours) and those sent to a remote lab (mine from late January) - both are more prone to false positives. I think you should re-test (re-read your last post and see that you are - good!). I would probably be even more of a stressed wreck regarding Tim if I didn't have a urinalysis from early February, and I certainly intend to have another one either at the first sign of trouble or when he's due for his annual exam in June.

Finally, I want to address this:
EDIT: I think you have hit on a valid point Denice in that dry food may not be the best, but one thing it CAN do is promote more water drinking in some cats which can keep crystals at bay. It will be good to see what Max's urine is like, which has always been good. 
I think this is valid for cats who eat all or mostly dry food to begin with. I don't think it's a good reason to switch a cat from a high-moisture canned and/or raw diet and/or homemade to a dry diet. Even if the cat drinks more, the cat is already so dehydrated that drinking more water might not make up for it. I have read that cats have a low thirst drive to begin with, so even with added salt, they might not drink enough. All of my CRF kitties that ate C/D were chronically dehydrated, even before developing kidney disease.

Currently, we are watching Tim's box habits closely for both urine and stools. Thankfully, both are good. Once we get Tim off cisapride, we will slowly transition him to more raw and/or home-cooked, which I hope will help all of his issues, including possibly being prone to urinary crystals. At the same time, we are trying to uncover the reason for all of his inflammatory responses (slightly elevated urine pH and possible struvite crystals included) so we can resolve this. But trust me, if something goes wrong, I'll do what I need to in order to make sure Tim doesn't block.

I hope you are able to manage this with Thomas.

Edited to add: Sorry this is so long!!
 
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oneandahalfcats

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Thanks. I hope so too. Its not the result I was expecting or hoping for but I have to keep things in perspective in knowing that this can be fixed quite easily.

Its rather ironic that my holistic vet and I were having the conversation recently around doing the urinalysis and bloodwork on Thomas as a routine as we haven't done any such testing yet. He's been very healthy. My vet commented at the time just how common crystals and UTIs have gotten. Normally urinalysis is done in times of trouble. Seldom is it done routinely. For this reason, many cats can have some struvite crystals and not cause a blockage or any other indications. But if enough sediment builds over time, it can form a stone. With two males, I know it is important to test their urine now and then. Maggie too.

I remember you mentioning the episode of crystals after switching to wet food, and thought it could be the fish. Through reading more on this subject, one of the things that came up was high carb content as another factor for struvite crystals. The thought is that depending on the carbs in the diet, this can change the ph from acidic to alkaline? I was feeding the Wellness Chicken for awhile as well but stopped, as it is one food that has a high carb content.

Ultimately, I think this is a lack of moisture issue combined with Thomas not being a frequent pee-er, and some possible predisposition. I am going to let the S/O play out and re-test. Re. the sample, this was taken early morning, was put in the fridge soon after and later tested as soon as I brought it in to the clinic. Sometimes, if a sample is left out at room temperature it can definitely change the result.

It's really tough having to learn the hard way about diet, especially when you lose beloved pets on account of not knowing. I am not looking to go backwards here in thinking that dry food is the fix. I tried different grain-free kibble with Max and Maggie before finally switching to wet canned. They have always been good drinkers and have never been dehydrated. If it wasn't for Max's constipation, we might still be on dry food. Ultimately, dry food can work for a long time for some cats, and for other cats, it can be catastrophic. Just depends on the cat. No rhyme or reason it seems. But I want Thomas to not have to go through what Max has, and so this is another reason for wanting to go the high protein/low carb species appropriate route.
 
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abbyntim

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I have also read that a higher-carb food can contribute to an alkaline urine, but in my experience it can really vary! And there may be other factors in urine pH. I recently reviewed Tim's records from the emergency vet as I try to understand what has happened to him and noticed that his urine pH was 6.0 in March 2011 when he was eating Blue Buffalo Wilderness chicken dry. It was also 6.0 in June 2013 when he was eating Taste of the Wild Rocky Mountain Feline dry. Then in January 2014, when he was eating Wellness canned turkey and chicken varieties (but only a week out from any fish varieties), it was 7.0. As you can see, Wellness is a bit lower in carb, yet his urine pH went up quite a bit. This, and because he suddenly started vomiting Wellness, then other chicken foods, is why I went (and still am) on a search for better food.

Looking at the websites for the various foods, knowing formulas may have changed since I fed them, carbs on a dry matter basis estimated from the guaranteed analysis:
  • Blue Buffalo Wilderness chicken formula dry GA: 100-(40[protein] + 18[fat] + 3.5[fiber] + 10[moisture] + 8[est. ash]) = 20.5/90 = 22.8% carb
  • Taste of the Wild Rocky Mountain Feline formula dry GA: 100-(42[protein] + 18[fat] + 3[fiber] + 10[moisture] + 8[est. ash]) = 19/90 = 21.1% carb
  • Wellness canned chicken or turkey GA: 100-(10[protein] + 5[fat] + 1[fiber] + 78[moisture] + 1.95[ash]) = 4.05/22 = 18.4% carb
  • Nature's Variety Instinct LID canned turkey GA: 100-(10.5[protein] + 7.5[fat] + 2[fiber] + 75[moisture] + 2[est. ash]) = 3/25 = 12% carb
Even the NVI LID, which is the best I have found for all of Tim's issues, is higher than the ideal 10% carb cap according to catinfo.org.

You are right that this is one thing that can be fixed, though it's scary during the process. I am very aware of what can happen inside a cat's bladder with sedimentation and mucous and how deadly this can be, particularly in a male cat. As such, I am obsessed with Tim's litter box habits (both kinds). I think your plan is a good one. Hopefully you can get Thomas on a good high-moisture low-carb food after a round of S/O and watch him for any issues, along with periodic urine tests. That's my approach with Tim right now.
 
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oneandahalfcats

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I have also read that a higher-carb food can contribute to an alkaline urine, but in my experience it can really vary! And there may be other factors in urine pH. I recently reviewed Tim's records from the emergency vet as I try to understand what has happened to him and noticed that his urine pH was 6.0 in March 2011 when he was eating Blue Buffalo Wilderness chicken dry. It was also 6.0 in June 2013 when he was eating Taste of the Wild Rocky Mountain Feline dry. Then in January 2014, when he was eating Wellness canned turkey and chicken varieties (but only a week out from any fish varieties), it was 7.0. As you can see, Wellness is a bit lower in carb, yet his urine pH went up quite a bit. This, and because he suddenly started vomiting Wellness, then other chicken foods, is why I went (and still am) on a search for better food.

Looking at the websites for the various foods, knowing formulas may have changed since I fed them, carbs on a dry matter basis estimated from the guaranteed analysis:
  • Blue Buffalo Wilderness chicken formula dry GA: 100-(40[protein] + 18[fat] + 3.5[fiber] + 10[moisture] + 8[est. ash]) = 20.5/90 = 22.8% carb
  • Taste of the Wild Rocky Mountain Feline formula dry GA: 100-(42[protein] + 18[fat] + 3[fiber] + 10[moisture] + 8[est. ash]) = 19/90 = 21.1% carb
  • Wellness canned chicken or turkey GA: 100-(10[protein] + 5[fat] + 1[fiber] + 78[moisture] + 1.95[ash]) = 4.05/22 = 18.4% carb
  • Nature's Variety Instinct LID canned turkey GA: 100-(10.5[protein] + 7.5[fat] + 2[fiber] + 75[moisture] + 2[est. ash]) = 3/25 = 12% carb
Even the NVI LID, which is the best I have found for all of Tim's issues, is higher than the ideal 10% carb cap according to catinfo.org.

You are right that this is one thing that can be fixed, though it's scary during the process. I am very aware of what can happen inside a cat's bladder with sedimentation and mucous and how deadly this can be, particularly in a male cat. As such, I am obsessed with Tim's litter box habits (both kinds). I think your plan is a good one. Hopefully you can get Thomas on a good high-moisture low-carb food after a round of S/O and watch him for any issues, along with periodic urine tests. That's my approach with Tim right now.
I know that some of the dry food is high in carbs for sure, but some of the canned is also too high in carb, which is why I mentioned the Wellness. If the 18% is accurate, this is way too high which is one reason why I decided to switch. It should be more like 3-4%. But GA aside, just looking at the ingredients will give you a good idea of the carb content. Things like potato, sweet potato, carrots, represent alkaline carbs and a lot of this is often high up in the ingredients list. I contacted Wellness recently on another matter and asked them at the time why their canned food features so much carb and got the standard reply that this is to replicate the plant-based food found in prey animals? I said but, you realize that the amount of digested plant material found in a mouse or bird is going to be very small, and none of it constitutes things like sweet potatoes or carrots, to which they said, we find that many of our customers like this diversity of ingredients? Wellness did say that they are currently looking at incorporating more low glycemic carbs like lentils to use as thickeners to replace carageenan, which was some good news.

As for a high protein, low carb food, all cats were/are presently on Nature's Variety food, except Thomas who will be doing the S/O for the next two weeks. The carb content of NV is 3%. I don't want to get too hung up on ph but instead focus on ensuring that Thomas gets sufficient moisture which should make him pee more and keep him in good shape.
 
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