Male cat with blocking issues

My 3 year old cat Biscuit had a couple of cystitis type episodes back in April & May. The vet said they were due to struvite crystals and we put him on Hills CD prescription food. 

Aug 31 he suddenly blocked and spent two days at the ER vet getting catheterized and unblocked. Struvite again, with a urine pH of 7.4, even on the special diet. We agreed that he'd likely been sneaking dry food with the other cats. He came home on oral antibiotics but seemed to struggle a lot with irritation, making litter box trips more frequently than usual and leaving small clumps. We resolved to keep him strictly to the prescription food and wanted to transition him to another brand (Royal Canin SO). My ultimate goal was to switch him to all wet food (yes, I've done LOTS of reading on that) but he is a picky eater and we found no urinary canned food he would eat so it wasn't going very well. 

Three weeks later he blocked again (it was obviously a struvite/mucus plug per the vet), and we spent another two days at the ER... catheter, etc.. This time when he came home he seemed much better. He was on low dose oral metacam for 4 days and it seemed to really help. We stayed with the prescription food but had discovered he would eat the Hills CD (fish flavored) so we are working hard to transition him... and he is now eating mostly canned food. We've even managed to work in some chicken flavor now because I know the fish isn't a good long term solution. His litterbox trips were 6-8 hrs apart and looking almost normal. 

Now we've gone a little over two weeks and suddenly we are having litterbox problems again. It started yesterday morning. He'll use the box... fairly normal size clump (for him anyway, his have always been kinda small)... then he'll spend the next half hour running back and forth to it producing only tiny drops. Clearly irritated.

Because he wasn't blocked, our vet prescribed more of the low dose metacam to reduce his inflammation. I gave it to him last evening and it worked pretty well all night... He only made one trip around 1am with two follow up trips. But this morning we seem to be worse... there was a good size clump in the box some time between 3:30am and 7am... and now we've made many trips over the past hour (it is a little before 8 now). 

I expect I will call the vet when they open and see what they suggest for today, but here's the deal...

The ER vet has recommended perineal urithrostomy (the surgery rerouting and enlarging his urethra) - this based on the two ER visits and the fact that he seems to manufacture struvite crystals even on the prescription diets. 

Research I've done seems to say that this procedure only helps reduce the chances he will block in the future. It also says there are no guarantees it will do even that... because the crystals are the real problem. Then there are risks of scarring from the surgery causing further problems... Sigh. 
 

I've read several other threads (the one about PU surgery in particular) so I know quite a bit now about the surgery. I've also read many of the theories about different diets and such. 

My problem is that I - apparently - have only a limited window of time to decide about this surgery unless I can resolve these bouts of cystitis. I've been holding my breath for two days now hoping he will not block... wondering what to do to help him through this episode.

Does anyone have any constructive advice for me? Anything I can do for my boy right now to help?  Anyone who would strongly recommend the surgery? Any drug therapies that help? Etc.? Just hoping for some kind of light in this tunnel... 

 

First let me say I'm sorry you and your kitty are going through this. Second I'd like to say that I am not a vet nor an expert... I'm neither advocating nor suggesting that you try this; just something to read and maybe look into or discuss with your vet.

Search the health thread using "ACV and Struvite crystals"

Was he put in a muscle relaxer, prazosin, after the cath procedure and did you continue with it through the other episodes?

As far as the surgery is concerned I do not have any experience with that because to me it was a drastic thing to do as a last resort. I opted not to do the surgery and was able to solve my cats issue with medications(muscle relaxer PRN) and food. I would change his food to another prescription brand I use Purina UR. Also Id place 3 to 4 times as many water bowls throughout the house to get him to drink more. I would also remove anything from your cats diet that contains fish. In hindsight I think that created the perfect storm for my cats blockage as that was all I previously feeding him. I think if more liquid is introduced in your cats diet the crystals may be dissolved in the urine.

I'll go research the other threads soon as I get back from our vet visit. Thanks for the suggestion!

He was not put on a muscle relaxer, nor a sedative of any kind (though we discussed xanax since he has a tendency to be easily startled and stressed.)  I'll ask about it today. 

I totally agree on the fish. In fact, I asked a friend who is a vet why there is a prescription for urinary issues that is fish based. All she could tell me was that she had no idea... but she was sure millions were spent on it... LOL.

I would never have introduced him to the fish flavored prescription diet except that he stopped eating the chicken based ones.  I've slowly been adding the chicken canned in with the fish to get him switched... Apparently I was not fast enough. 

Hi Tiger.I agree with surgery it is not all cut out like it should be.There can be complications.And crystals are mostly caused by a dry diet/stress.We can never get enough canned food or water into our kitties.I belong to the FLUTD group at Yahoo.Super group with over 30 yrs experience.Some natural healing,soothing remedies you will not hear from a vet as well as longterm members who have had many a cat with this.Diet is a huge part of it but so much more.Pls come over & join us.We are very personable & will take  care of you & our babe to the best of our ability.Huge file section on anything and everything you wanna know as well as meds that should be prescribed but are not.The wrong type of meds being prescribed for pain etc.A huge read about foods in general & why going canned is www.catinfo.org by Dr.Pierson.Any canned food is better than the best brand of dry..

Our link is

https://groups.yahoo.com/neo/groups/FLUTD/info

Well he should have been on muscle relaxers and a pain med both. This is standard protocol for post cath blockages. I'd get him on the muscle relaxers before opting for surgery if your vet won't do it I'd find another because this alone can ease a lot of pain and get the urine flowing and your car actually wanting to pee. There is a psychological component to blockages, if left in too much pain a kitty will associate peeing with pain and not do it thereby creating a whole new problem and contributing to crystal production. I have to get me kitty to a cat specialist to learn that and it made a lot of sense to me. The surgery is technically amputation of the penis and I couldn't see it as an option unless everything else was exhausted. My kitty is crystal free for a year now.