Chronic FLUTD/FIC due to physical trauma?

[luda macka]

Hey all, I'm asking here because I'm struggling with one of my cats (Penny). Penny seems to be suffering from chronic flutd/fic but my sister and I have no idea what would be causing it. Or rather, HOW would it be causing it.

So, to get some things out of the way:

• I also have two other cats (Pippin and Soot) who can be somewhat intense with Penny so I do genuinely keep all their interactions to a literal minimum.
• All cats are on 100% wet food diet, and Penny has also been on a specific medical diet for flutd/fic/urinary issues (Royal Canin, Hill's, Animonda Integra, Kattovit..) for years now.
• I have at least 5 litter boxes spread throughout my apartment. They are cleaned frequently throughout the day, every day. I use clumping litter.
• I also use Feliway/Felisept inffusers throughout the apartment etc to help with calming down or stress or whatever.
• All cats are NOT free-fed, they have their meal times, and they eat separately so there is no food being stolen from another cat etc.

I realize stress can be a factor (and I do think/recognize it IS a factor for Penny), and I know Penny is an easily stressed/timid/shy cat. But I am at my wit's end to be honest.

Every few months: she essentially cycles with struvite crystals, then we go to the vet, she gets pain meds, anti biotics, anti nausea meds, and meds to stimulate appetite.. and of course, all this time she is on her medical wet food for urinary issues. Then it's back to "normal" (but not really), and then again. And then every time during these vet visits, when we do like a quick urinalysis test...her pee is always showing some crystals in her urine and her leukocytes are 3+, and her urine pH is 6.5. Everything else (blood work, the rest of urinalysis) is normal, more or less.

But we are constantly dealing here with a cat who is holding in her pee (unless we're at the vet or we have to bathe her because she has pee or poop all over herself, then she just releases the waterworks!), and then either 1) strains to pee some times, 2) holds her pee so long that she isn't aware it is there, and then she pees over herself in her sleep (either a tiny amount or the whole amount), 3) when she is better, she does go pee on her own and manages to pee a good amount but you know..it literally happens SOME times and SOME times it does NOT. But related to point 3), her "better phase" doesn't last too long, and we are back at square one.

So, physical trauma? When she was 1-2 years old (she is now 13 years old), she had an accident where she was outside exploring but unfortunately got hit by a car. She luckily and thankfully survived, didn't have any bone fractures. However, at the time of the accident, due to the physical trauma, impact and shock- she couldn't walk so she dragged herself by her two front paws, and she was constipated and blocked. In that time, we took her to the vets where one confirmed with an xray that "yay, no bone breaking" and then the other one confirmed with an ultrasound that she was backed up. So, we tried to administer oils or whatnot (this was so long ago, I don't really remember, and I was a tween back then when it happened, and also of course the vet was administering all those things) to help her poop and stuff. It was not happening. So after this long week, she ended up having an operation where they emptied her out. After this, she (as well as my other cats) are now 100% indoor cats only.

Since then:

• Very soon after her operation, she very quickly regained the ability to walk (a miracle!) but she is walking in a way that it's obvious that something is wrong with her back legs and she is also dragging her back feet with her (understandable)- however all this hasn't stopped her from climbing or running around my apartment etc
• Due to her back legs, she can't put herself into the regular pee or poop cat pose that a healthy cat would do when going to the toilet- either I (or my sister) help her with the toilet where we hold her above the litter and then massage her lower abdomen area to help stimulate her to pee or poop depending on what she needs OR when she goes by herself, she sort of plops down with her butt on one side and then goes
• She also struggles to poop, so she does deal with constipation some times and slow mobility of her intestines, I think

I know from this, that she has issues with her lower spine and whole lower abdomen nerves/nerve tissue, where her bladder and intestines/colon are located. With the holding in her pee, and then peeing in her sleep..my vet described it as overflow syndrome but I only agree with it partially since there ARE times when she does feel the urge to go, gets up and then goes to the toilet (when she's doing "better").

And for her back legs/lower spine/nerves, she never had an MRI or CT or PET scan done and I don't know if that would help? Because like all those years ago, previous vets never mentioned doing anything of that sort. I don't even know if we had that technology for pets in my country back in 2010/2011 when the accident happened.

I don't even know if it's even possible if her bladder tissue is messed up due to the nerves?? Like if her nerves deteriorated (most likely) and then because of that, the bladder lining/structure changed or whatever, which then causes it to not be a good place for urine, and then her urine changes into a mess that's causing her issues etc. It's like a dark circle where there is no end in sight.

I'm just completely lost and don't know what to do.

I don't even know what I'm expecting what I'll find, but I just know that for the time my cat has left to live- I don't want her to spend that time in pain.

Because it happened again, 2 weeks ago, she was struggling to pee YET AGAIN, we took her to the vet- quick urinalysis test shows struvite crystals but some tiny amount of calcium oxalate stones as well, leukocytes 3+, pH 6.5, some blood. After a week of pain meds, anti biotics, anti nausea meds (along with her urinary food), calcium oxalate stones are gone, blood is gone, everything else is negative, but her leukocytes are still 3+ and she still has big amounts of struvite crystals present. Today we had a vet check up where we did a full blood panel (everything was fine), and we have done urinalysis test where they take urine straight from the bladder with a needle so we're waiting on tests for that. Also did an ultrasound and there were no physical objects or blockages. I just don't know anymore.

It's literally constant.

 

[silent meowlook]

Ok, so the ultrasound didn’t show any stones in the bladder? That’s good. If the vet feels she is overflowing, perhaps the could teach you to express the bladder. Although yon would have to be carefull to not traumatize it more. Was the urine sent to the lab or done in house?

 

[luda macka]

We would usually do quick urinalysis test at the vet clinic, however this time (as well as few months ago) we also sent her urine sample obtained straight from her bladder with a needle to an outer laboratory that will do extensive testing.

The thing is, she only overflows some of the times, and then also when I would help her with peeing, she would refuse to pee. And if I can't make her pee, then I'm just annoying her and stressing her out even more

I also added her latest quick urinalysis results from the vet clinic into the main post. I can further update the thread with other test results as they come in.

Thanks everyone. <3

 

[luda macka]

Oh, it seems I cannot edit the post haha. That's fine. Anyway, here are the results.

From the latest quick urinalysis test done at the vet's clinic, her results are as follows:

LEU 3+ 500 Leu/uL
NIT - neg
URO - 0.2 mg/dL
PRO 2+ 100 mg/dL
pH 7.5
BLO - neg
SG 1.015
KET - neg
BIL - neg
GLU - neg
ASC - neg
SPEC. T. 1.046

I just want to note about her pH..most of the time it is exactly 6.5, but in this most recent test it says it's 7.5 because we were briefly feeding her with non medical wet food just for her to EAT ANYTHING since she was refusing to eat.

 

[FeebysOwner]

What does your vet say about all of this, and are they suggesting any further testing, such as you mentioned above? Has your vet ever consulted with a vet university or a specialist to see if they might help to shed some light on her condition - or, advise regarding the most appropriate additional testing that could be done?

There are a lot of odd or unusual things going on with all the information you offered above. When you say the ultrasound showed 'no physical objects or blockages', I presume you mean besides the struvite stones the vet said she has plenty of? Also, oxalate stones do NOT dissolve like struvite stones, so if they are 'gone', does that mean she passed them (which I would think would be painful)? While it is good there was no blood in her urine, the high WBC count is indicative of inflammation - somewhere in her urinary tract system. Did the ultrasound that was performed also look at her kidneys and ureters?

I know you said her blood work was fine - what blood work did they run - CBC & Chemistry Panel? The latter would be more helpful in terms of checking her kidney (and other organ) function.

All said, if you haven't brought in some specialists and/or consulted with a vet university, I would strongly suggest all of her records/tests be shared with one or the other and see if they can provide some additional guidance. Looking for structural/organ issues (abdominal ultrasound), as well as checking for nerve issues (CT scan, I think) would be good ideas.

 

[silent meowlook]

Was it the vet or the lab that saw the crystals?

 

[luda macka]

What does your vet say about all of this, and are they suggesting any further testing, such as you mentioned above? Has your vet ever consulted with a vet university or a specialist to see if they might help to shed some light on her condition - or, advise regarding the most appropriate additional testing that could be done?

There are a lot of odd or unusual things going on with all the information you offered above. When you say the ultrasound showed 'no physical objects or blockages', I presume you mean besides the struvite stones the vet said she has plenty of? Also, oxalate stones do NOT dissolve like struvite stones, so if they are 'gone', does that mean she passed them (which I would think would be painful)? While it is good there was no blood in her urine, the high WBC count is indicative of inflammation - somewhere in her urinary tract system. Did the ultrasound that was performed also look at her kidneys and ureters?

I know you said her blood work was fine - what blood work did they run - CBC & Chemistry Panel? The latter would be more helpful in terms of checking her kidney (and other organ) function.

All said, if you haven't brought in some specialists and/or consulted with a vet university, I would strongly suggest all of her records/tests be shared with one or the other and see if they can provide some additional guidance. Looking for structural/organ issues (abdominal ultrasound), as well as checking for nerve issues (CT scan, I think) would be good ideas.

They haven't really referred us to a specialist, no. Not even further testing, they think that it could potentially be a waste of money and potentially not say much, especially since it's been a long time after her accident.

Yes, I mean besides the struvite crystals present. Sorry, I should have been more clear about that. It's when they analyze her pee under the microscope, that they see a lot of struvite crystals and then the vet tells us that. When it comes to calcium oxalate ones, yes we asked about that- the vet said there was a tiny amount there, not enough to warrant a operation. Because upon me getting information that she had calcium oxalate stones, I immediately got home and googled and found out that they do not dissolve and are removed through an operation. But like I said, a week after (after antibiotics, pain meds, anti nausea meds), when we re-did the quick urinalysis test at the vet: struvite crystals present, no calcium oxalate stones and blood was also negative. Only her leukocytes were still 3+ and protein 2+.

So with that, we came back again for a proper urinalysis where they took her urine straight from the bladder with a needle, and they have sent that to an outer laboratory for more in depth testing.

The ultrasound was only performed on her bladder I think. We didn't look at her kidneys or urethra. When it comes to the blood panel, the one was called an extensive full blood panel, and the other one was called biochemistry profile. The first one came back okay. And the second one we got results today where the vet said that her kidney enzymes are okay, but her liver enzymes are higher and her protein is way higher. So now, we are coming back with her to the vets for the next 5 days for her to get IV fluid and then re do the biochemical profile and see from there. I will get both tests printed out so I can post them with exact numbers as well.

And yes, my sister and I are looking in fact to bring her to a specialist, and neurologist to further discuss her state and how best to help her to improve her quality of life.

Was it the vet or the lab that saw the crystals?

It was the vet under the microscope in their clinic.

 

[fionasmom]

Just to answer one small part, if there is nerve damage in the area of the bladder or bowels, it can affect the ability to use those organs. In the case of your cat though, it sounds as if the bladder varies between rigid and flaccid.

 

[luda macka]

Yeah it does seem to me like that as well. Thank you for your input!

 

[silent meowlook]

Hi. If it was my cat, I would get her to an internal medicine specialist and have a full abdominal ultrasound done.
Some arriviste crystal fragments can be mistaken for calcium oxalate crystals.
The reason for a specialist doing the ultrasound is that it is a very subjective test, so you want someone doing it that has the extra training and knowledge. Otherwise it’s a waste of money and time and stress to the cat.

 

[luda macka]

Thank you for your reply. I will try to get her to an internal specialist, if there is such a thing in my country.

Can you elaborate what you mean by "arriviste crystal fragments "? I tried googling but google did not give me any proper results...

 

[fionasmom]

I agree that even if you can't get to an IM specialist, you want someone experienced with ultrasounds doing the procedure and reading it, more importantly. My regular cat vet did an echocardiogram on one of my cats, read it with the radiologist and prescribed medication which the cardiologist completely over ruled when we finally saw her. She was quite arch about not letting just anyone take a swipe at reading a US.

 

[luda macka]

Oh I agree. I will definitely try getting her to specialist's care, because I feel like I am currently going around in circles with my veterinarians.