Vet didn't find anything in the urinalysis

parsleysage · May 1, 2014

I'm having a hard time understanding what's going on with Garfunkel and how to move forward.

Background: Last year he had what they called a UTI, he was going in & out of the box a bunch of times without going. He was empty, not blocked. We weren't able to get a urinalysis. Last Saturday after we took the boxes out to dump and wash them, we brought them back inside and Garfunkel couldn't wait for us to put the new litter in - he hopped in and peed on the bottom of the box. That's when I saw there was blood in it, and we took him to the e-vet. As always, he was empty (vet said that was normal as they will keep very little urine in their irritated bladder because it's painful).

So, I took him for a urinalysis on Tuesday and got the results yesterday. Other than a small amount of blood, the vet didn't find anything remarkable in the UA. No infection, no crystals. An abdominal x-ray at the e-vet turned up no stones anywhere, and a US at the regular vet showed no grit in the bladder.

The vet said it could be stress, and also mentioned our suboptimal number of litterboxes (2 LARGE sterilite tubs for 3 cats). We'll be adding a third litterbox in a different location.

I also put them back on wet food. Though I'm a little frustrated at all the conflicting info I've read for what is or isn't good for them. It shouldn't be this hard to feed cats! They're eating mostly Wellness canned. I am going to try and rotate in some other brands. I hope I'm doing the right thing.

They have a water fountain.

So other than the add'l litterbox and the wet food... what are we looking for? What is the diagnosis? Most of the advice online is for kitties who do have crystals or other signs of urinary issues. What should I do about a kitty with blood in his urine but no other symptoms?

I'm confused and frustrated, and I still get panicky and scared when I think about the short timeframe male cats have from their first symptoms to life-threatening blockage... each week I work a Wednesday-Friday stretch where I'm out of the house nearly 14 hours each day and come home late at night, well after midnight; my boyfriend is home in the evenings but he doesn't know much about cats. What if we miss something during that timeframe? It's very nerve-wracking, especially not knowing what his problem is or how to treat it. Could use some advice and vibes.

goholistic · May 1, 2014

So the ultrasound didn't show any inflammation of the bladder?

I was thinking it's possible that Garfunkel could have bladder inflammation, which can result in bloody urine, but not necessarily bacteria or crystals. It's usually termed Feline Idiopathic Cystitis (FIC) or Interstitial Cystitis and is quite reactive to stress. Perhaps the inflammation wasn't severe enough to get picked up by the ultrasound.

If your vet thinks this might be the case, I'd keep stress triggers to a minimum. Products like Bach's Rescue Remedy for Pets (the alcohol-free version), Feliway diffusers, and Jackson Galaxy's Spirit Essences can help create a relaxing environment. There are also calming treats made for pets. In more challenging cases, some owners have had to resort to an oral supplement or prescription medicine to reduce stress.

Some holistic treatments to help soothe and strengthen the bladder include corn silk and glucosamine/chondroitin. Always discuss the use of supplements with your vet.

I'm glad to read you put them back on wet food. A moisture-rich diet (ideally an all-wet diet) will help keep the body hydrated and the bladder flushed.

There are lots of threads about FIC on TCS and a quick Google search results in a lot of online articles. This particular TCS thread may be helpful: http://www.thecatsite.com/t/270626/feline-idiopathic-cystitis-advice-support

oneandahalfcats · May 2, 2014

parsleysage said:
I'm having a hard time understanding what's going on with Garfunkel and how to move forward.

Background: Last year he had what they called a UTI, he was going in & out of the box a bunch of times without going. He was empty, not blocked. We weren't able to get a urinalysis. Last Saturday after we took the boxes out to dump and wash them, we brought them back inside and Garfunkel couldn't wait for us to put the new litter in - he hopped in and peed on the bottom of the box. That's when I saw there was blood in it, and we took him to the e-vet. As always, he was empty (vet said that was normal as they will keep very little urine in their irritated bladder because it's painful).

So, I took him for a urinalysis on Tuesday and got the results yesterday. Other than a small amount of blood, the vet didn't find anything remarkable in the UA. No infection, no crystals. An abdominal x-ray at the e-vet turned up no stones anywhere, and a US at the regular vet showed no grit in the bladder.

The vet said it could be stress, and also mentioned our suboptimal number of litterboxes (2 LARGE sterilite tubs for 3 cats). We'll be adding a third litterbox in a different location.

I also put them back on wet food. Though I'm a little frustrated at all the conflicting info I've read for what is or isn't good for them. It shouldn't be this hard to feed cats! They're eating mostly Wellness canned. I am going to try and rotate in some other brands. I hope I'm doing the right thing.

They have a water fountain.

So other than the add'l litterbox and the wet food... what are we looking for? What is the diagnosis? Most of the advice online is for kitties who do have crystals or other signs of urinary issues. What should I do about a kitty with blood in his urine but no other symptoms?

I'm confused and frustrated, and I still get panicky and scared when I think about the short timeframe male cats have from their first symptoms to life-threatening blockage... each week I work a Wednesday-Friday stretch where I'm out of the house nearly 14 hours each day and come home late at night, well after midnight; my boyfriend is home in the evenings but he doesn't know much about cats. What if we miss something during that timeframe? It's very nerve-wracking, especially not knowing what his problem is or how to treat it. Could use some advice and vibes.

This sounds precisely like what my female went through. She was going in and out of the litter box and actually laying down in it at one point. Cats do this for two reasons. One, the litter box is a place that represents security to them so they will sit or lay down there when feeling stressed. Two, cats will sometimes wait in the litter box trying to go which can be a sign that they are blocked. In my case, following an examination and cystocentesis where they draw urine from the bladder, my female was not blocked and nothing was found in the way of crystals, or blood, but there were some white blood cells, indicating infection and/or inflammation. We concluded that this behavior was due to a stress reaction. My young tuxedo is often pestering this older female and so we are actively taking steps to reduce the situation between them. Following a course of antibiotics, my female is back to peeing fine.

This can be a rather frustrating situation as the cause of stress is not always as evident as it was in my case. Some possibilities to think about would be :

- Any recent changes in litter type, or location, or litter that needs to be changed more frequently

- Strange cats in your area that your kitty might have seen through the window

- A recent stressful event in your home

- Frequent changes in diet

I would start keeping a closer eye on your kitty and take note of any unusual behavior. If you have other cats, look for changes in association or aggression. Ask your boyfriend to be observant while you are away and make notes as well.

Originally Posted by GoHolistic

Perhaps the inflammation wasn't severe enough to get picked up by the ultrasound.

Inflammation and/or infection is usually indicative of white blood cells in the urine.

peaches08 · May 2, 2014

oneandahalfcats said:
Inflammation and/or infection is usually indicative of white blood cells in the urine.

Did you mean that white blood cells in the urine are usually indicative of an infection? Inflammation, however, can happen without the presence of WBCs in the urine.

@parsleysage you said you put the cat back on wet food? Were they changed to dry at some point?

oneandahalfcats · May 2, 2014

peaches08 said:
Did you mean that white blood cells in the urine are usually indicative of an infection? Inflammation, however, can happen without the presence of WBCs in the urine.

WBC can be indicative of infection, inflammation, or something more serious depending on the number and type. If there was some kind of disease, you might also see RBC along with WBC.

peaches08 · May 2, 2014

oneandahalfcats said:
WBC can be indicative of infection, inflammation, or something more serious depending on the number and type. If there was some kind of disease, you might also see RBC along with WBC.

Yes, they can be indicative of infection, inflammation, or something more serious. However, sometimes a urinalysis is performed and no WBCs are present. Since the UA was performed on Tuesday (blood seen on Saturday) I agree that this may be a case of FIC and worth mentioning to the vet.

goholistic · May 2, 2014

oneandahalfcats said:
WBC can be indicative of infection, inflammation, or something more serious depending on the number and type.

I pretty much agree with this statement. And I also agree, generally, that inflammation causes an elevation in inflammatory cells. But this is not always the case with FIC. The bladder seems particularly susceptible to neurogenic inflammation - inflammation triggered by neurotransmitters, which are sent from the brain in response to something like stress.

This document discusses FIC in a unique way:

It is now known that certain nerves within the bladder can be stimulated, either by the brain (in response to 'stress'), or by local triggers within the bladder (eg, inflammation, bladder stones, concentrated urine, infection, etc.). Regardless of how these nerves are stimulated they release certain neurotransmitters, which can then act to induce and/or exacerbate local pain and inflammation. Where inflammation is triggered by the nervous system it is termed neurogenic inflammation.

http://www.merialvetsite.com/sites/barnfieldvets/309flutd.pdf

There are no absolutes with FIC, and thus why they have termed it as such. There can be symptoms with a totally clear UA.

I do know that @angelsmommy, @LDG, and @tulosai have experience with cystitis in their kitties. Perhaps they can read over @parsleysage's post and see what they think this might be.

goholistic · May 2, 2014

GoHolistic said:
I do know that @angelsmommy, @LDG, and @tulosai have experience with cystitis in their kitties. Perhaps they can read over @parsleysage's post and see what they think this might be.

Whoops! I just realized that I tagged the wrong Angels mommy! It should have been @Angels mommy. Sorry!

parsleysage · May 3, 2014

Thank you all very much for the input.

Correct, the US showed no inflammation. (I knew the vet had said "no something else" along with "grit" but couldn't remember what it was when writing the post.)

His behavior, other than the urgency to go when we brought the boxes back in, has been normal. He is active, isn't displaying urgency any longer, does not appear to be in pain, no hiding, no hissing, no more or less loving than usual. He did not yowl or even mewl during the EXTREMELY uncomfortable looking exam by the vet Tuesday - I swear to god I thought he was gonna pull Garfunkel's bladder OUT OF HIS BODY trying to feel for any pee in it!!!!! And Garfunkel had no reaction. If in pain/inflammation present, shouldn't he have reacted in some way to the very strong manipulation of the supposedly painful area? I'm just at a loss... right now to me he seems to be a totally normal cat... just with blood in his urine.

I appreciate the info about FIC and I will definitely do more research into that condition.

At this point, what should I do?

parsleysage · May 3, 2014

Oh, and regarding stress... I really can't think of anything. No cats in the area as far as I can tell, they watch the windows but have never shown aggression towards anything outside. At night he sleeps with us in bed. He's technically "second" in the pecking order, but only by default because Simon definitely IS NOT second, lol. They are litter mates and are a very close bonded pair. They wrestle, play, and cuddle, but no aggressive fighting, nothing like how they treat my poor little Joni.

And @peaches08 unfortunately their diet has tracked with my financial circumstances. I could give a long background haha but it's likely not relevant. To keep it short, after last year's episode I put them on wet but couldn't afford to keep it at 100%. I moved to dry food and tried to give them wet when I could afford it. They had been on dry about 7-8 months prior to this episode. Now they are "back" on wet. It's just as expensive as it's always been, but I can afford wet food a lot better than I can afford surprise vet bills, or losing my Garfunkel.

We're going to add the third litterbox and I am going to double and triple ensure maximum cleanliness. Just in case the vet is right about the too low # of boxes causing stress.

oneandahalfcats · May 3, 2014

parsleysage said:
Thank you all very much for the input.

Correct, the US showed no inflammation. (I knew the vet had said "no something else" along with "grit" but couldn't remember what it was when writing the post.)

His behavior, other than the urgency to go when we brought the boxes back in, has been normal. He is active, isn't displaying urgency any longer, does not appear to be in pain, no hiding, no hissing, no more or less loving than usual. He did not yowl or even mewl during the EXTREMELY uncomfortable looking exam by the vet Tuesday - I swear to god I thought he was gonna pull Garfunkel's bladder OUT OF HIS BODY trying to feel for any pee in it!!!!! And Garfunkel had no reaction. If in pain/inflammation present, shouldn't he have reacted in some way to the very strong manipulation of the supposedly painful area? I'm just at a loss... right now to me he seems to be a totally normal cat... just with blood in his urine.

I appreciate the info about FIC and I will definitely do more research into that condition.

At this point, what should I do?

Actually, you want to be careful when examining the bladder as the wall of it is very thin (think of the bladder as a balloon), and so I am surprised and a little concerned with your vet's approach. I guess it depends on the extent of the blood and what the cause of this is as to whether Garfunkel is in any actual pain. Usually blood in urine indicates the presence of a high amount of crystals that are scraping the bladder wall. That said, when my tuxedo was diagnosed with crystals, he had not been having problems with peeing, there was no blood and he did not appear to be in any pain at all. The crystals were found through a routine UA. In looking under the microscope, there weren't a lot of crystals but enough that we needed to do something about it.

Have you had a blood panel done on Garfunkel? If not, you might want to have this done to look at kidney and other organ function, to rule out issues elsewhere. Its not clear if the urine samples have been free catch or obtained through cystocentesis. Urine can change from one sample to the next, and sometimes urine tests can produce false negatives and positives, and so I would repeat the UA, to see if there are any differences. I would also have a urine culture done to rule out bacteria as a cause for the blood.

Glad to read that Garfunkel seems to be feeling fine and doing well otherwise.

goholistic · May 4, 2014

parsleysage said:
At this point, what should I do?

Since his behavior is normal and you are taking preventative measures with wet food and low stress, you might just have to keep an eye on him. Keep in contact with your vet and ask if, and when, another urinalysis might be needed.

angels mommy · May 4, 2014

Hi all, sorry, I am just seeing this. I haven't been on as much lately, ( I've been in the midst of "making over my living room!") Anyway, I agree with all the info already given. I'm not sure I can add much.

Angel did have sturvite crystals in his bladder, & after trying just about everything, to avoid a Rx food, that is what it took in the end. He had a regular urinalysis, & US w/ in 2-3 wks. after starting it. As much as I hated putting him on it, (by products etc..) I was SO mad at myself for not doing it sooner, & he could have felt better sooner! I too struggled w/ the cost, especially Rx food (canned) from the vet, but YES, I think the same after All those expensive visits. I will gladly spend $40.00/case of canned Rx food, rather than have him suffer, or pay more high vet bills!

My vet knew how I felt about it, so she looked at all three different Urinary food formula's (they carried) w/ me & the Purina UR SO seemed to have the least "bad stuff."

I think the others were Royal Cane & Hills?

My vet did show me that Angel's bladder walls were thick. He was put on Cosequin to help w/ the bladder inflammation, & I have kept him on it as maintenance ever sense.

(& he is around 10 or 11 yrs. old now anyway, so good for the joints). At the vet's it was originally given Desequin, but that is very expensive at the vet's. (like 20 something dollars/bottle).

I found Cosequin (same ingredients) on line, & have been buying that instead.

I also have been keeping a Feliway plugged in. After shopping around, I have found the best prices for both are either on Entirely Pets.com, Or amazon.

I also still & always will continue to add some water from the PUR filter in his meals, just to make sure he gets plenty of water.

If your kitty is still having blood in his urine, I would do as oneandahalfcats suggested, in getting other things tested like his kidneys, etc.. just to be on the safe side, & to find out where it's coming from.

I hope everything is "all clear though."

Vet didn't find anything in the urinalysis

parsleysage

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goholistic

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peaches08

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goholistic

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parsleysage

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parsleysage

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