One of my cats still having accidents/bloody pee after treatment for urinary blockage & infection

Hey guys, we're currently trying to treat one of my family's cats for a urinary infection. This is our first time dealing with a male cat with urinary issues. I had a few questions that I was hoping some members who have had experience with this could help me answer.

Our cat, Samson, was rushed to the vet last Monday. It turns out that he had a total urinary blockage. We caught it really early, so it looks like he didn't suffer any more renal damage (he's in the early stages of CKD), but he's getting a blood test Monday to check his levels. Also, thankfully there were no crystals in his urine. Our vet thought this was all brought on by intense separation anxiety he feels when my mom is traveling.

He had a catheter in for 24 hours. When we took him back to the vet, it was clean, so they took it out. Samson went in the litter box, which was awesome. In addition to the antibiotic and anti inflammatory he has been prescribed for the infection, our vet wanted us to get him on Clomicalm for his anxiety. After we gave him the first dose, he started to get really lethargic. We noticed he was swaying side to side, sleepy, and he was dribbling all over himself and not cleaning it up. Which isn't very in character, since he's usually pretty clean.

Back to the vet just to make sure he's not crashing, and we were recommended to halve the dose. I guess it's quite common to start cats off at a very strong dose and make it lighter. We decided to just stop this medication altogether, and possibly start it once the urinary problems clear up.

It's now been 5 days, and Samson is still accidentally letting some pee go in inappropriate places. He's still using the litter box 3/4 of the time. It's just sometimes he will be sleeping, then come out of his hidey hole and his rump will be all damp with pee. Or, when we give him his medication in the bathroom, he'll go to a random spot and just dribble on the floor. His pee is way less red than before, but it still definitely has some blood in it.

Is it normal for a cat to still have accidents like this? I mean, I could see it when he was super stoned on that medication, but I'm concerned that it's still happening. Sometimes he's cleaning himself after, sometimes not. When he goes in the litterbox, it's about the size of a ping-pong ball. If your cat has still had issues like this after treatment for the infection has started, how long did it take to go away?

He's also drinking a good amount, but avoiding food unless its really stinky. I guess one medication kills his appetite and one makes him nauseous, so it's not unexpected, but still kinda worrying. We're doing our best to make sure he gets enough to eat. He's perking up a lot more today, and even asked for some chicken I was eating for lunch. But still, his rump was damp and sure enough, he'd had an accident where he'd been sleeping. 

Thank you to anybody who has some advice! This is our first go round with bladder issues. Samson does have an appointment with the vet tomorrow morning to check his blood.

Recovery from the acute stage often takes about three weeks.  I can't give info on the clomicalm because I have not used it.  I use small doses of lorazepam (0.25 mg.) once daily (nightly) n my FLUTD cat during the first 3 weeks.  She also got pain medication (buprenex) and some kind of urinary antipasmodic for the first week.  You are only in your first week.  Don't panic.  Hopefully he will do well, but it's a major thing he went through and he doesn't recover overnight just because he is unblocked. 

I thought it was just fine when she puddled all over the floor (yes this one is a she, but my friend's was a he and same things apply.)  I would follow her around and dip a pH test stip in her urine and make sure it was staying between 6.0 and 6.5, andif it crept up towards 7.0 I would give her 1 cc. of organic apple cider vinegar and water, diluted 1 part vinegar to 4 parts water, every half hour and would keep doing it until the pH dropped.  The reason for this is that struvite crystals, which are the most common urinary crystals in cats, will dissolve in a slightly acidic urine.  Even if she is not blocking, struvite crystals are like microscopic shards of glass and can irritate the bladder and urethra and cause that blood in the urine.  She had a tendency for her urine to get neutral (pH 7.0) or even slightly alkaline (7.25 to 7.5 sometimes) which can be related to stress, and when tht would happen, she would get blood in her urine.  As long as the pH stayed between 6.0 and 6.5 there was no blood in her urine.  Also, as she felt better, she used the box more and more.  When I first got her, she was peeing blood in small amounts every 15 minutes, hardly any urine, just bright red blood.  By the end of the first week, there was no blood visibly.

Also there was a diet involved.  First, she had been in a shelter on nothing but dry food for 1 1/2 years.  I had to get her onto a wet food diet right away. I didn't like the ingredients in the so-called prescription diets (Hills, Royal Canin, Purina) so I went to www.catinfo.org to look up foods that might meet what she needed, something close to a cat's natural diet, with high meat (not vegetable) protein, moderate fat, and very low carbohydrates (i.e. no grains, starches, peas, potatoes, carrots, legumes etc.) and that diet would cause her urine pH to be mostly between 6.0 and 6.5.  The vet agreed that was the right level to shoot for.  I started with EVO 95% turkey & chicken, but it's very high fat, so later I got the 4Health grain free canned turkey & giblets dinner, mixed in a little Beech Nut baby food chicken (you can't use Gerbers, they add corn starch to it, it adds 20 calries per jar) and also sprinkled just a tiny bit of L-methionine from the health food store into that.  L-methionine also tends to acidify the urine, as it is a natural amino acid found in meat, and a meat diet acidifies the urine while a high carb (grains and starches, fruits and veggies) diet tends to make it more alkaline.  Again, whether or not I added it depended on her continuing urinary pH.  It varies through the day, but as long as it never reached 7.0,she will nt form struvite crystals.  I found that to be true.  Once she had days where she never got into the 7.0 range, there was never any blood at all.  This has been true for nine months now, and she isn;t getting any additives anymore, her metabolism has been reset. 

The other kind of crystals cats sometimes make in their urine (although these are more common to dogs and humans) are calcium oxalate crystals.  They are more likely to form in acid urine, but pH does not matter so much to them.  What prevents them forming is having lots ofurine, and that's why an all wet food diet is required.  Evidently the ingredients to make up these crystals must be concentrated in the urine, as they are when a cat lives on nothing but dry food, so just feeding wet food, at least 3 or 4 times a day, i  things enough to wash out the bladder of anything that might be a problem.  [There is a published study that discovered that one food could actually prevent both kinds of crystals, and this diet is based on that study.]

My friend in rescue had a rescue cat that blocked, a male, and he spent several days in the hospital being unblocked and having his bladder flushed daily.  When he came home, we put him on this diet and she checked his pH every time she could (even damp fur is sufficient for the sticks to work.) and for him it has been 6 months and he is still fine.  He is on the 4Health food also, which costs 69 cents a can, and also sometimes just Friskies pate -- anything with mostly meat and no grains or starches works for the pH.  That's how cats eat in the wild and they don't get urinary stones and blockages.

Don't sweat the accidents he has this early on.  Give him some time.  Ping pong balls are a fine size at this stage.  If you want me to send you some pH test strips, PM me with your address and I will do that.  You can order them from eBay also, very inexpensive, under $3 for a pack of 180.  It's a reallly good thing to keep track of the urine pH for awhile because you dont have to guess about whether or not he's about to make crystals.  Hang in there.  Even if he reblocks a couple of times on the way to full recovery, you can get through it.