Blocked Tom / Urethra / Urethral Obstruction - now low Hematocrit / HCT Anemia ?

On Wednesday, 8/5/15, my cat (Joey) was unable to urinate. He is a 14-year-old neutered male. Indoor only. He has received regular veterinary care - always. We even do regular dental cleanings.

We've had issues with Joey urinating outside of the box for 5 months. We've tried antibiotics (3 kinds), anti-anxiety meds (Buspar - which made him seem more agitated), and a special diet (Hills c/d). He's been to three different clinics to see different doctors. No one has ever detected crystals in the urinalysis, ultrasound or x-ray. 

2 weeks ago we found urine on our couch, and then he urinated on our bed (we know he was the one who urinated on the bed). He's never done anything like that before. Prior to that, he always went on "puppy pads" right next to the litter boxes. He always "poops" in the litter box. We have more than enough litter boxes. We keep them clean. We have tried other types of litter. We have both boxes with lids and without lids.

On Wednesday, Joey hadn't urinated for around 24 hours and when I touched him around the bladder, he yelped. We immediately took him to our veterinarian. The doctor said she found a crusty substance around the prepuce. She noted that his penis was bluish in color and so she immediately sedated Joey and inserted a catheter. She said his penis turned pink again. Joey has been producing a normal amount urine for the last 48 hours with the catheter in. At first, his blood work showed very slight elevation of BUN (30.8) and creatinine (1.5), glucose was 306, LOW Calcium (8.8), Potassium (3.4) and WBCs (2.1). This doctor suspected that crystals were present but that no one had ever been able to find them.

Yesterday (8/6), we saw a different doctor. He said he thought the blockage was due to behavioral issues and that Joey was refusing to urinate, which caused spasms and that the spasms caused the blockage. (Joey is the most laid-back cat I've ever known, he's the oldest cat in our household, and none of our other cats mess with him - in fact, the other cats seem to adore him.)

Joey has been receiving IV saline plus potassium, buprenex, and amoxicillin for two days. The only food he would eat was a little boiled chicken last night around 10 PM.

Today (8/7) he has an increased temperature (104.3), WBCs are up to 12.0, BUN normal (22), Creatinine normal (1.4), Potassium is normal, Calcium is still low, glucose is around 200, there was also a little bit of bacteria in his urine but not a large amount. His RBCs have decreased from 6.83 to 5.15, his hemoglobin (HGB) decreased from 11.7 to 9.0, his hematocrit has decreased from 32.7 to 27.4 The new doctor we took him to today seems VERY concerned about both the increased body temperature and the low hematocrit. His bilirubin is normal. Liver function tests are also normal. There is no bilirubin in the urine either. The doctor sent out a test for FIV and Feline Leukemia (he was tested as a kitten and was negative and all of our cats have been tested and also negative). I will be very shocked if Joey tests positive for either virus.

Could the hematocrit and RBC issue be because they're pushing so much IV fluid to clear his bladder? Could the increased body temp. be because of stress and discomfort? What other things should we be looking for?

Does anyone have any thoughts about causes of the urination issues? What really caused the blockage? What can I do to decrease the chances of future blockage (other than the special food, which I will continue.) I know they can perform surgery - perineal urethrostomy (PU) - should I ask about that?

Does anyone have experience with anti-anxiety meds? Should I try a different kind?

The new doctor we saw today would like to have a specialist perform an ultrasound on Joey's abdomen. She can schedule the exam early next week or we can also go to a specialist if we want to have it done ASAP.  Does anyone have any thoughts or suggestions about that?

Thank you for any and all help!

Ally >^..^<

If Joey was fairly dehydrated and a blood count was taken, fluids given afterwards could cause the hematocrit levels to appear to fall due to dilution of the blood from the extra fluids. I would think that the levels would stabilize once Joey is fully hydrated. If the levels continue to decline even after Joey is "full", then you might need to look for silent bleeding or blood disorders. Many blood disorders can be successfully treated if caught early!  Did Joey have any "casts" in his urine? Casts are leftovers from Red Blood cells, White Blood cells, proteins, and other misc particles that are present in the urine...usually these can give clues to problems that might not be obvious. The fever sounds like it is due to an infection, which makes sense since Joey's WBC is getting higher as well as the bacteria in the urine. A high amount of White Cell casts usually indicates kidney or bladder infections.

   Crystals can form in the kidneys much like they do in humans. The most common way for crystals to form is from sustained dehydration. I'm not talking about bad health dehydration, more like a mild but continued lack of water, which can cause the crystals to precipitate out of the urine. Getting your cat to drink more water is probably the easiest and maybe best way to prevent crystals and stones. My cats love their "fountain" as it entertains them as well as encouraging them to take a drink. Your cat's diet also has a large influence on crystal formation depending on the ingredients, as some brands seem to have a lot of minerals in them that can contribute to stone and crystal growth. Wet food actually has a lot of water in it, so a wet food diet could probably help with hydration.

   I have never used any anti anxiety meds on any of my cats, but have never really had a reason to need one. I'm still not sure if I feel that many of the SSRIs and similar "New Gen" meds are appropriate for cats to use. I wish you the best in getting your urination issues resolved. I feel pretty certain that there might be an infection that is causing all of this...please keep us informed of Joey's progress!

Jim

Did you ask all these questions of the last Vet you saw?  All the blood values need to be looked at TOGETHER, not individually, so it takes someone with lots of experience to understand them.  And as to WHY things happen...sometimes they just do.  Sometimes it's food, sometimes dehydration (often) sometimes it's genetics, sometimes it's stress, sometimes it's a combination of things. 

One thing I would NOT consider right off the bat though is the P/U surgery.  It's too soon, in my book, to be thinking of that.  Usually that is done only if a cat blocks more than once.

There are quite a few cats here on TCS who have been or are currently on anti-anxiety meds.  If the Buspar didn't work, I would definitely think about trying a different one, although you said you don't think he's stressed out

Thank you both for your responses!

They found no casts in the urine sediment. There were just a very few (like 1-3) WBCs and RBCs per hpf in the urine - which they said could be caused by the insertion of the catheter itself.

I have considered trying a water fountain. Do you have any opinion on which one is best?

We did talk to the doctor today about the lab results. She seemed very perplexed about the combination of abnormal results. She did say Joey's blood serum looked very dark yellow (darker than normal, but not hemolysed), however his bilirubin was normal. She talked with the other doctor on staff and they pretty much decided on a "wait and see" approach. We have decided to do the ultrasound and will follow up with more blood tests Monday or Tuesday.

For now, Joey is home. He's on antibiotics. Temp. is down to 102.7. He is eating and urinated in the box when he got home. (Also urinated at the office earlier this afternoon.)

We're going to watch him very closely this weekend to make sure he doesn't get blocked again. We do have a place we can go for emergencies over the weekend if needed. They even showed me how to check Joey's temperature and I bought him his own thermometer... I haven't tried that yet, but I will try in an hour or so.

Thank you again for your help! I'll let you know what happens - if anything changes over the weekend - and I'll post an update after we do more tests next week.

AllyKat08 said:

 
Thank you both for your responses!

They found no casts in the urine sediment. There were just a very few (like 1-3) WBCs and RBCs per hpf in the urine - which they said could be caused by the insertion of the catheter itself.

I have considered trying a water fountain. Do you have any opinion on which one is best?

We did talk to the doctor today about the lab results. She seemed very perplexed about the combination of abnormal results. She did say Joey's blood serum looked very dark yellow (darker than normal, but not hemolysed), however his bilirubin was normal. She talked with the other doctor on staff and they pretty much decided on a "wait and see" approach. We have decided to do the ultrasound and will follow up with more blood tests Monday or Tuesday.

For now, Joey is home. He's on antibiotics. Temp. is down to 102.7. He is eating and urinated in the box when he got home. (Also urinated at the office earlier this afternoon.)

We're going to watch him very closely this weekend to make sure he doesn't get blocked again. We do have a place we can go for emergencies over the weekend if needed. They even showed me how to check Joey's temperature and I bought him his own thermometer... I haven't tried that yet, but I will try in an hour or so.

Thank you again for your help! I'll let you know what happens - if anything changes over the weekend - and I'll post an update after we do more tests next week.

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I've read over your posts, his results are confusing. I do agree that it is a bit early to consider PU surgery. Can you see a cat specialist possibly an internist?  I strongly advise you to stick with the canned rx food, if he will eat it, it is much better than dry kibbles plus if he'll eat it when you mix a little extra water in the food, that would help immensely. What antibiotic is he on? If you haven;t already done so, I suggest if you can, keep him in a separate room or area from the others as you can tell exactly how much urine he is passing.   By any chance is he possibly a free-bleeder?

Hi nansiludie.

We currently give him both canned food and dry food, but he doesn't seem to eat much of the dry. Should we take the dry away for now? (Or forever?) I will add a bit of water to the canned food. We also have separated him in the family room with us and will keep him separated from the others for the weekend. The antibiotic is zeniquin. I just now checked his temp. and it's down to 102.0 (it really wasn't that difficult!), so he's still improving.

We will wait on the PU surgery.

When you say free-bleeder, do you mean something like a clotting or coagulation disorder? I've never heard that term before.

Thank you for your help!

Ally

If your cat is getting blocked up from crystals, I would strongly recommend giving him only distilled water. My male cat had this problem a few times and the vet recommended distilled water. As long as he is only given distilled water (no tap or bottled water either) he is perfectly fine.

cc0000 said:

 
If your cat is getting blocked up from crystals, I would strongly recommend giving him only distilled water. My male cat had this problem a few times and the vet recommended distilled water. As long as he is only given distilled water (no tap or bottled water either) he is perfectly fine.

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That seems "do-able" -- I guess that cats get the minerals and nutrients they need from their food and they don't need to get them from water?

Thank you for responding!

The tap water is typically OK for cats unless you have very hard water, since the amount of dissolved solids (minerals) is often very small and generally not enough to influence blood levels of the minerals involved. With that being said, not all tap water is created equal and distilled water might be better tasting and has a lot less of other contaminants in it. I remember the water in Miami looking like pee water...it was actually yellow from all of the chlorine and other stuff. Water keeps the kidneys from making too concentrated of urine, which cats having concentrated pee to begin with. When it is concentrated and a lot of minerals are present, then they can precipitate out of the urine, causing crystals and stones.

  I'm not sure what brand of water bowl I use...it has a storage tank on the back and it recirculates the water via a small waterfall type of outlet. Cats seem to like this a lot more than a regular water bowl and they drink a lot more from it...at least my 4 did! I hope all goes well with your kitty and that the crystals are gone for good. Wet food adds a lot of hidden water to your cat's diet...if you get a fountain your water problems should hopefully go away. Good Luck!!

Jim

AllyKat08 said:

 
Hi nansiludie.

We currently give him both canned food and dry food, but he doesn't seem to eat much of the dry. Should we take the dry away for now? (Or forever?) I will add a bit of water to the canned food. We also have separated him in the family room with us and will keep him separated from the others for the weekend. The antibiotic is zeniquin. I just now checked his temp. and it's down to 102.0 (it really wasn't that difficult!), so he's still improving.

We will wait on the PU surgery.

When you say free-bleeder, do you mean something like a clotting or coagulation disorder? I've never heard that term before.

Thank you for your help!

Ally

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Yes, I think the canned would be best. Yes, that is what I meant by free-bleeder, much like having a blood-clotting disorder. It is good to have him by himself to keep an extra close eye on him. His temperature seems good. I wonder if he was especially stressed on the ride to the Vet, him being blocked and everything, if that cause his temperature to spike a little at the Vets office, especially now that it is summertime.

How's he doing? 

Joey seems to be doing pretty well today. No fever. Using the litter box. (YAY!) Drinking water, but not excessively. Mainly, I think he's annoyed that he's being forced to stick to ONLY the special diet. Maybe he's bored with eating the same thing all the time? He acts really excited when he hears me opening the can of food, but when I give him the food, he sniffs it and nibbles a little, and then walks away. He DOES eventually eat it though. Previously, I was sometimes giving him canned Fancy Feast - but not anymore.

On Saturday, I ordered him a water fountain from Amazon. We have Amazon Prime, so it should arrive today.

Does Friskies Special Diet work? I wonder if it would be okay to give him that food sometimes? I guess I really should ask the doctor about that... I truly think he seems bored with the same food every day.

We have an appointment at 10AM today to take Joey in for new blood work.

I'll keep you posted. Thanks again to all of you!

Ally

AllyKat08 said:

 
Joey seems to be doing pretty well today. No fever. Using the litter box. (YAY!) Drinking water, but not excessively. Mainly, I think he's annoyed that he's being forced to stick to ONLY the special diet. Maybe he's bored with eating the same thing all the time? He acts really excited when he hears me opening the can of food, but when I give him the food, he sniffs it and nibbles a little, and then walks away. He DOES eventually eat it though. Previously, I was sometimes giving him canned Fancy Feast - but not anymore.

On Saturday, I ordered him a water fountain from Amazon. We have Amazon Prime, so it should arrive today.

Does Friskies Special Diet work? I wonder if it would be okay to give him that food sometimes? I guess I really should ask the doctor about that... I truly think he seems bored with the same food every day.

We have an appointment at 10AM today to take Joey in for new blood work.

I'll keep you posted. Thanks again to all of you!

Ally

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What RX food is he on? Usually there are two to three different varieties/textures in the same line of food. Yes, I think asking the Vet would best given Joey's special condition. What color is your Joey? I have a cat named Joey, he is a smoke tuxedo. Grey body and tail with traditional face mask and white feet/belly.

AllyKat08 said:

 

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What a handsome kitty! I am not familiar with the Royal Canin foods, is the SO version of that rx food equal to the Hills CD kind? I know the Hills SD is not meant to be fed for a longer period of time.

There are other urinary foods out there, but Friskies no longer makes theirs.   Iams and Purina both make a Veterinary formula, then Purina Pro Plan makes a non veterinary one, so does Daves.

So glad that at least Joey is feeling better, even though he's not liking his food so much. 

It's interesting that none of the doctors said the special diet is intended for a limited time. They all act as though Joey will have to be on this diet for the rest of his life.
 

Yesterday's blood work did show improvement. However, his hematocrit is still below normal at 29.7% (30%) is the lower limit of normal - I know 29.7% is not terribly low - but it still worries me because I don't know the cause. The doctor plans to recheck the blood work and examine Joey again in one month - unless something seems to go wrong before then.

Back to the food... Joey seems really annoyed about the food situation. I can definitely tell he is feeling better today because he has been walking around the house, checking all of the usual "feeding spots." He goes to each spot and "cries" at us as if he's begging for something better! The poor guy really dislikes his special food. Funny thing though, one of my other cats got a taste of it and seemed to love it! Yesterday, the doctor said it was fine to use Hills cd, and I bought a couple of seafood varieties, but this still hasn't satisfied Joey. I want him to be happy as well as healthy. So frustrating!

Does anyone know of a way I could make my own homemade food for Joey? Are there any recipes out there? I've been searching Google and not having much success. Yes, I am willing to cook for my cat! <3

That's awesome. There is a forum here that can help. Look under raw food and homemade food.

AllyKat08 said:

 
Does anyone know of a way I could make my own homemade food for Joey? Are there any recipes out there? I've been searching Google and not having much success. Yes, I am willing to cook for my cat! <3

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I have used this recipe with good success with my kitties, even my urinary issue prone males. I use Dr. Pierson's recipe. http://www.catinfo.org/?link=makingcatfood

For me, the rx food was just too expensive to feed to as many as I have. My kitty Whiskers also did not like it very much. He was on Hill's C/d.