cystitis/Dexamethasone

pinktree

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Hello, I have an 8 year old female cat named Palmer who has struggled with cystitis flare ups which usually occur once or twice a year. I am pretty familar with the basics of this condition including lots of water, feeding wet food, regular litter box cleaning and stress reduction but this past week she is having a flare up that I can't seem to get under control. A few days before she starting going frequent small amounts for some reason she held her urine for over 28 hours so I immediately took her to the vet. The took a urine sample, did blood work and gave her a 2mg shot of Dexamethasone. Dose anyone know if this shot should have started working by now, it has been four days, she is still going tiny amounts and not making it to her littler box on time. I had to see a different vet this time and he said he said he doesn't like giving antibiotics if there is no infection so he went with the Dexamethasone. The last time she had a flare up she was given a covenia shot and got better in one day, is it possible that the antibiotic could work that fast? Should I take her back for a different opinion or wait a few days? I don't know If this has anything to do with her flare up but I noticed that she is coughing up hair balls two nights in a row now which is rare for her, could a blocked hair ball be causing her problems. Any advice would be appreciated. Thank you!
 

maggiemay

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So she was given the steroid shot four days ago?  It should be working by now.  If Palmer is not urinating normally and is also coughing up hair balls, which you say is rare for her, I would get her looked at again quickly. The Convenia shot has always worked fast on my bunch.  I would take her to a different vet and get the shot if it worked well on her last time.  You know your cat and you know what worked on her before.  I definitely wouldn't wait a few days; these urinary problems can turn into very dangerous situations rapidly.  

One of my babies had a blockage in his urethra a few months ago.  He was very sick, and stayed at the clinic for five days getting antibiotics, steroids and sub-q fluids.  He has been doing great ever since.  I suffered from cystitis myself some years ago until I began taking cranberry daily.  Since that time, I have never had another episode of it.  I found a brand of cat treats - Get Naked Urinary Health treats - which contain cranberry. Tigger absolutely refuses to eat the wet prescription food the vet prescribed, although he will eat other brands of wet food. I've been feeding him the wet food that he will actually eat with extra water added to it, and supplementing with these treats, several in the morning and several at night.  They are chicken flavored and he loves them.  So far, the cranberry treats have kept his urinary tract functioning perfectly, so he is able to eat normal food.  I get mine at Chewy.com. After Palmer has been treated for this episode of cystitis, I think these might help her as much as they help Tigger.  I also use a homeopathic product, Natural Pet Cat Urinary Tract Infections, which I add to his water bowl once a day when I change the water.  You can buy it at Only Natural Pet and possibly at Chewy.  The box says it's for cats straining to urinate, those who frequently urinate and for dribbling.    

Another thing you might try to keep her urinary tract healthy is Slippery Elm Syrup.  Here's some information on Slippery Elm and the recipe for the syrup, which I have used for digestive issues, cystitis, etc. in my cats.  I swear by it.

Slippery Elm bark contains natural pentosans, a class of complex sugars that contains the same compound found in the drug “Elmiron[emoji]174[/emoji],”the major pain-relieving treatment for interstitial cystitis (IC) in women.  In the case of cystitis (bladder inflammation), Slippery Elm is thought to soothe the bladder lining. Since bladder disease in cats is very similar to that in women, slippery elm may be especially beneficial for our feline friends. Small, frequent dosages of pentosan has been shown in humans to be more effective than single large doses.

Author Anitra Frazier gives the following recipe for Slippery Elm Bark syrup in her book, The New Natural Cat: Into a small saucepan place 1/2 cup cold water and 1 teaspoon powdered slippery elm bark. Whip with a fork. Bring to simmer over low flame, stirring constantly. Simmer 1 or 2 minutes or until slightly thickened. Cool and refrigerate. Keeps 7 or 8 days. Give a teaspoon of syrup (5 cc) for an average-size cat (again, about 10 pounds) 5 minutes before a meal.  Do not give at the same time other medications are given.  Slippery Elm soothes all of the mucous membranes in the body.  I add 1/2 of an eye dropper of the syrup to wet food or give via syringe orally prior to meals.  I order my Slippery Elm Bark capsules from Swanson Vitamins because I trust their quality, but most major pharmacies should have slippery elm bark capsules in their vitamin/supplement section.  I hope this helps and I hope that Palmer is feeling better very soon.  Prayers for you both!
 

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Are you feeding her a LOW-CARB food with 10% or less of carbs, and meat as the main ingredient?  Do you ever test her urinary pH?  If her problem is being caused by struvite crystals, those cannot grow in a slightly acid environment, and cat urine should be 6.0 to 6.5 which is slightly acid.  Feeding grains and fiber can increase that natural pH to one that allows the growth of crystals, which can then irritate the bladder wall, even in the absence of infection.  If her pH is not staying below 6.5 (You can use test strips on even just the few drops she is passing) you can give her a solution of Bragg's organic apple cider vinegar  mixed 1 part vinegar to 4 parts water, give 1 ml. by mouth every half hour and keep testing until the pH returns to 6.5 or lower.  While our vet was right to assume that she does not have an infection, she is also of an age where she would be more likely to have one than a younger cat, so if she isn't responding as you would like, you should get a culture and sensitivity done of her urine.  That will show (1) if she does have any bacteria in her urine, and (2) if so, the sensitivity test will show what antibiotics its sensitive to.  By the way, this advice isn't hearsay, I have used this method with 100% success on a couple of cats so far after doing a lot of research.  I took a cat the shelter was going to put to sleep because of her recurrent urinary problems, two vets had given up, they used Convenia and it did nothing for her other than mess up her digestion (probiotics fixed that in time).  She has been totally symptom-free for over six months now after 18 months of constant problems and bloody urine before I took her.  When she came here, she was peeing small amounts of very bloody urine every 15 minutes, and she was in obvious pain and grunting and straining when she urinated.  We started with antispasmodics, pain medication (buprenex) and L-methionine to help dissolve all the crystals, plus using canned Evo 95% Chicken & Turkey food with just a dash of L-methonine sprinkled lightly on it, plus the vinegar once daily (except when the pH would rise).  It no longer rises, but stays around 6.0.  With the new diet she doesn't need any additives.  The male we treated the same way is now symptom-free four months after having his bladder flushed by the vet a couple of times to get rid of the crystals fast because males have a tendency to block, which is life threatening.
 

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Red Top Rescue, this is a wonderful post!  I use Bragg's myself, but never thought of using it on my cats.  Do you use the normal pH strips or are there some made for cats?  Thanks so much!
 

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Since your vet has ruled out infection I am assuming there were also no crystals found and that this is idiopathic cystitis.  Here is one article on it http://bluepearlvet.com/feline-idiopathic-cystitis-fic/    It sounds like you are doing a lot of the things for it.  Feliway does help some kitties as does interactive play.  Laser pointers aren't recommended.  They actually can be frustrating because kitty can never 'catch' them.

Some kitties need more and sometimes amitriptyline is used.  There is also a surgery that can be done that scrapes the lining of the bladder.  Both of those are usually last resort type things.
 
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pinktree

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Thank you all so much for your replays, I really appreciate every response. She means so much to me, I am willing to do anything I can and pay any amount of money for her to feel better. I am trying to read all of your posts quickly so I can go back and sit with her but there is some really good information here. [emoji]128512[/emoji]

MaggieMay- thank you for your long reply. The steroid shot was given on Tuesday, I thought it would have started working by now too. I was surprised when the vet said bring her back in if she's not better by Monday because it seemed like a long time. I am going to keep a close eye on her tonight and if she's not better there is an emergency vet I will take her to. Do you know if cystitis can ever go away on its own, I defiantly won't wait if she's not getting any better but if she is improving do you think its ok to wait until Monday so I can see her regular vet? I will look into these supplement for sure, thank you for the suggestion and I'm glad your kitty is better!

Red top resume- thank you for your information. I have to feed her wellness turkey and salmon with a little water on it because she has food allergies and it took me trying six different types of food until she stopped itching. She is allergic to chicken and guar gum which is in every canned food that I have looked at. Do you know off hand any low card food that dose not have chicken or guar gum in it? I will do my research to see if I can find one.

Denise- thank you for your help. Her blood test and urine sample did come back normal. I remember reading that laser pointers aren't a good toy. I do have the deli way plug ins too. You are right I only want to use a medication like that as a last resort.

I remember during a flare up one time her vet gave her a shot of metacam that did work very well but she said it could only be used once in a lifetime, is that true? Thanks so much again!
 
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pinktree

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Sorry or a second rely but I was just thinking we got a new blue ray player and Palmer has been sleeping on top of it, it feels warm, do you think her bladder could have became inflamed from the heat off of the blue pray?
P's I am going to look into those ph strips, thanks for the tip,
 

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If she seems to be improving or stable, you should be fine waiting until Monday to see Palmer's regular vet.  I would check her little bottom from time to time and make sure there is no blood or pinkish discharge either on her fur or in her urine.  If you see pink, take her to the emergency vet, because she probably has a little blood in her urine.  I personally have never seen cystitis simply go away on its own. The steroids should be working to reduce the inflammation, but you should have seen more progress by now.  A steroid shot usually works for a minimum of a couple of weeks.  I am very hesitant to use steroids, but for occasional use they can't be beat and they usually work much more rapidly than this, by the next day or two. Heat can make inflammation worse. Palmer probably finds the warmth comforting, but she may be aggravating the inflammation in her bladder, so I would keep her off the blu-ray player.  Has she been sleeping on it since she got the steroid shot?  If so, that may be contributing to the problem.  Is she still eating normally?  If she is, I would add a little water to her wet food. As far as stress reduction, do you have any Rescue Remedy?  If you do have Feli-Way, use that as well. The charts of all four of my cats say "no Metacam" in great big letters, at my request.  Please don't let her have any more Metacam, it can cause very severe side effects in many cats.  Above all, try to remain calm yourself, because she will pick up on your mood in a heartbeat.  They're so attuned to us, and can tell when we panic.  Your precious little girl will be fine, just keep a close eye on her, check for pink or red, keep her off the blu-ray player, and add water to her food.  If anything changes, you know you have the emergency clinic option, and if she is okay through tomorrow, I would be at the vet's office when they open.  I've done that many times and have never once regretted it.
 
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pinktree

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Thank you so much MaggieMay for that advise, I feel calmer after reading your reply. :wavey: I will update tomorrow. Thanks again for the help!
 

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Hi, your post reminded me of a video I watched recently by Dr. Karen Becker, she talks about recurrent infections, it's here-http://healthypets.mercola.com/sites/healthypets/archive/2010/01/06/prevent-urinary-tract-infection-in-cats.aspx She also has this one which is kind of like an overview http://healthypets.mercola.com/site...-Indicate-Your-Pet-has-a-Bladder-Problem.aspx      

Also, just an FYI in case you ever need to know, if she does have struvite crystals, which occur when the ph is too high (above 6-6.5 for cats) the vet can give you (or you can buy it in a health food store if it's cheaper maybe) DL-methionine. Royal Canin Urinary S/O puts it in their formula to acidify urine. My cat was on Royal Canin years ago and now I wonder why the vet didn't recommend DL-methione as another option, I don't think many people know about it.

Nutri-Vet also makes a product called URI Ease that has DL-methionine and some other helpful ingredients if your cat needs help acidifying her urine. With the ph test strips you could monitor her better at home and give some if needed with your vet's supervision. I also saw something called Urinary Tract Irritations water additive at the pet store. I looked it up on Google when I got home and it's made by Tomlyn Natural Pet. The reviewers had lots of good things to say so I was thinking of buying some to have on hand.
 

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Red top resume- thank you for your information. I have to feed her wellness turkey and salmon with a little water on it because she has food allergies and it took me trying six different types of food until she stopped itching. She is allergic to chicken and guar gum which is in every canned food that I have looked at. Do you know off hand any low card food that dose not have chicken or guar gum in it? I will do my research to see if I can find one.
 
The Wellness grain-free you use fits the bill perfectly so you don't need to find a different food unless she is getting too fat on it (like the Evo I was using, it's very high fat, good for skin and coat but a bit to high for some cats who gain weight on it.  Here are the statistics on that food from the Food Chart on www.catinfo.org:

Wellness  Turkey & Salmon canned food 5.5 oz. cans

Percentage by Calories (as eaten)

Calories:           182

Protein               37%

Fat                     58%

Carbs                  5%

mg Phosphorus per 100 kcals   299

Percentage on Dry Matter Basis

Protein 50%

Fat 33%

Carbs 7%

mg Phosphorus on dry matter basis = 1.44
 

red top rescue

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Also, just an FYI in case you ever need to know, if she does have struvite crystals, which occur when the ph is too high (above 6-6.5 for cats) the vet can give you (or you can buy it in a health food store if it's cheaper maybe) DL-methionine. Royal Canin Urinary S/O puts it in their formula to acidify urine. My cat was on Royal Canin years ago and now I wonder why the vet didn't recommend DL-methione as another option, I don't think many people know about it.

Nutri-Vet also makes a product called URI Ease that has DL-methionine and some other helpful ingredients if your cat needs help acidifying her urine. With the ph test strips you could monitor her better at home and give some if needed with your vet's supervision. I also saw something called Urinary Tract Irritations water additive at the pet store. I looked it up on Google when I got home and it's made by Tomlyn Natural Pet. The reviewers had lots of good things to say so I was thinking of buying some to have on hand.
With commercial amino acids when you see the "L" this indicates the natural form of the amino acid.  The "D" form is the synthetic mirror image.  So DL-methionine is also a synthetic form of methionine and much less expensive than the pure form.  Some studies show L-methionine as being more effective while other studies show both L and DL being equally as effective.   You can buy the NATURAL form of methionine, which is L-methionine, made by Source Naturals, in powder form.  This is useful when trying to get the urine pH into the proper range when you are treating the problem early on, but it is not needed permanently as an additive because methionine is an amino acid which is readily available in meat and fish protein. 

I bought mine from the following:  http://www.iherb.com/Source-Natural...dF_O22nC9AFomZFwDJP0pknl8g3g4patFQaAqAY8P8HAQ
 

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You really do have to be careful about adding any type of acidifier.  If there are no crystals or pH issue then they can create the opposite issue which is calcium oxalate crystals, they are actually more difficult to treat.  They cause stones which have to be removed surgically.

If the urine sample was clean then I really think it is the idiopathic cystitis.
 

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If you can get her some buprenex before Mondays appointment-this would help greatly and stop the straining in the litter-of course we try to wait until Monday vet but if she is still going in and out of the box-

I recommend calling an er vet to get her some pain meds and sub fluids if she doesn't have cardiac issues.

-and yes its true metacam is only used once. It puts a lot of strain on the kidneys/liver if I remember correctly-used the way it was meant for=surgery-is how its supposed to be used.

Buprenorphine or tramadol are two options for pain meds for cats but tramadol is only in pill form and I prefer buprenorphine=its a liquid that is absorbed through the blood vessels in the mouth-so it only has to go into their cheek pocket or under the tongue-its a very tiny dose=.015ml so it is probably easier than a pill.

buprenorphine is a narcotic and lasting 8 to 12 hours and I have had a cat with bladder spasms-she was very uncomfortable-they gave her convenia and pain meds as well as sub fluids=in 24 hours she greatly improved-sometimes stress itself can cause what's called idiopathic-meaning-no infection or bacteria present but the symptoms are like an infection and kitty of course is very uncomfortable=-my kitty hid her discomfort so well that I didn't know for a few days-she waited until no one was around to scuttle to the cat box=I noticed the box was used more often but I couldn't pin down WHO it was-so three days later I was home from work and stacked out the area to watch-my pumpkin face is a very shy kitty=she is a closet pee and eater=she doesn't like anyone watching-

Luckily the meds did the trick-we did a urine scan 2 weeks later and no infection-she actually had all kinds of junk in her urine-proteins and RBC and WBC-they didn't get enough urine to send out for sensitivity testing-they just decided to try the convenia and it worked. I know there are many people who have not been as lucky-the one thing my vet said is convenia works well for E. Coli and that's what she suspected  was causing trouble-there are two ways e coli can cause issues=either from the outside and getting up the urethra into bladder OR it is in the digestive tract and hitches a ride in the liver etc area and go through the bloodstream to stop at the kidneys/bladder. She said its common that this could happen this way-she said its nothing I did to cause this.

Keep us posted-

and yes you can add some cranberry supplement to the wet food to see if it helps-but make sure the list of active and inactive ingredients doesn't show any artificial sweeteners=I didn't know that they are very bad for our animals-both dogs and cats.
 

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@FairyCatMom  - the Urinary Tract Irritations product by Tomlyn is the product I posted about earlier that you add to their water bowl.  I misread the box and should have called it Urinary Tract Irritations rather than Infections.  You add 1/2 teaspoon to their water bowl each time you give them fresh water.  This is completely homeopathic and it seems to be working very well for my Tigger, who had a severe blockage of the urethra several months ago.  The paw gel product that used to be so great was reformulated in 2011 and now is horrible, unfortunately. ALL the Nutri-Vet paw-gels now contain "sodium benzoate."   Sodium benzoate is toxic to cats in even trace amounts!   I highly recommend the Tomlyn product.  Very easy to use and since there is absolutely no taste, there is no problem getting them to take it.  When I wanted to get some of it into his system quickly, I added a few drops to his cranberry treats and that worked well.  I am also considering a product from Only Natural Pet that consists of Chinese herbal drops; it has wonderful reviews.  I am trying to find the right type of Methionine.  If you know where to purchase that, I would very much appreciate the information.  Thanks!
 

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You really do have to be careful about adding any type of acidifier.  If there are no crystals or pH issue then they can create the opposite issue which is calcium oxalate crystals, they are actually more difficult to treat.  They cause stones which have to be removed surgically.

If the urine sample was clean then I really think it is the idiopathic cystitis.
The reason for using pH test strips is to avoid going out of the "safe" zone, so the urine is neither too acid nor too alkaline.  pH does vary throughout the day, tending to  be less acid right after eating.  Calcium oxalate crystals require a pH consistently less than 6.25, plus a concentrated urine, plus available oxalate and calcium in the urine.  Hypercalciuria, a risk factor for CaOx urolithiasis, has resulted from hypercalcemia, metabolic acidosis, high sodium consumption, and vitamin D excess. Consider adding potassium citrate (75mg/kg q12-24hr), if urine pH is consistently less than 6.2).

"High moisture foods (i.e. canned formulations) are more effective because increased water

consumption is associated with decreased urine concentrations of calculogenic minerals.

Feed canned foods and/or add increasing amounts of water to food until specific gravity is less

than 1.030."

Oxalobacter formigenes is an intestinal bacterium that ingests oxalate as its sole nutrient.  By consuming dietary oxalate in the intestine, less oxalic acid is available for absorption and less is excreted in urine. To preserve healthy populations of intestinal Oxalobacter, avoid indiscriminant use of antibiotics.
 
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pinktree

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Thank you so much for everyone replays. I just came on to give a quick update. Palmer seems to be doing better then yesterday. She is still urinating more than normal but she is making it to her litter box today. There is also no sign or blood or even pinkish color so I am thankful for that. I am leaving a message for her vet to see what we should do tomorrow.
Fairycatmom-thank you for the video link I will be sure to watch that asap.
Red top rescue- I'm so glad the wellness is an ok food to give her. She is 8 pounds so there is no trouble with weight gain. Thank you for that info.
Foxxycat- thank you for that medication info I will be sure to ask her vet about it. Glad your kitty is better, was hers idiopathic cystitis too, do you think the burpernex would be enough to bring down the inflammation, I am not familiar with that medication or do you remember how long after starting the medication She felt better?
I just had one question since her bt and urine sample came back normal I do believe it is idiopathic cystitis like her last flare up so why did the antibiotic covenia help her las time if there was no infection? The vet I saw this time said they don't like giving antibiotics unless there is an infection that is why he chose the steroid? Thanks again everyone, :wavey:
 

red top rescue

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 I am trying to find the right type of Methionine.  If you know where to purchase that, I would very much appreciate the information.  Thanks!
Source Naturals L-Methionine free-form powder is what I use, sprinkling just the tiniest amount over her food -- it tastes rather like "meat" and she likes it.  I got it through Amazon.


Here's the Source Naturals info page.

http://www.sourcenaturals.com/products/GP1181
 
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red top rescue

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Thank you so much for everyone replays. I just came on to give a quick update. Palmer seems to be doing better then yesterday. She is still urinating more than normal but she is making it to her litter box today. There is also no sign or blood or even pinkish color so I am thankful for that. I am leaving a message for her vet to see what we should do tomorrow.
Fairycatmom-thank you for the video link I will be sure to watch that asap.
Red top rescue- I'm so glad the wellness is an ok food to give her. She is 8 pounds so there is no trouble with weight gain. Thank you for that info.
Foxxycat- thank you for that medication info I will be sure to ask her vet about it. Glad your kitty is better, was hers idiopathic cystitis too, do you think the burpernex would be enough to bring down the inflammation, I am not familiar with that medication or do you remember how long after starting the medication She felt better?
I just had one question since her but and urine sample came back normal I do believe it is idiopathic cystitis like her last flare up so why did the antibiotic covenia help her las time if there was no infection? The vet I saw this time said they don't like giving antibiotics unless there is an infection that is why he chose the steroid? Thanks again everyone,
Idiopathic cystitis often gets better on its own.  One of the amusing sayings is "It will get better within 7 days on antibiotics or in a week if you use no antibiotics."  The down side of antibiotics, especially Convenia, is that they kill off the natural good bacteria in the gut, so if you aren't also using probiotics, then you can upset the natural balance and make things worse.  You are already using a good food, so if you just add a little water to it all the time, just having the water to make the urine less concentrated will help.  As for the buprenex, it is NOT an antiinflammatory, it is just a pain killer.  The importance of pain killers is that they reduce stress by reducing pain, and pain = stress, and stress is part of this condition. 
 
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