History Of Urinary Problems - Cystocentesis This Week Vs Specialist Visit In Half A Month

[lazer]

Hi all,

One of my cats has a history of urinary problems and hates vets. Last Monday we rushed to the emergency room when he was peeing drops of blood. They did a full blood panel (all clean) and he was on Metacam for five days. Last Wednesday I brought in a urine sample which I got by holding a cup under him (no more visible blood in the sample, and now peeing a normal amount, so seemingly improved). Today I heard from the vet that the urine sample had a small amount of protein (possible from the blood/bladder irritation) and white blood cells, indicative of potential infection. They want me to bring him in on Wednesday to do cystocentesis for a clean sample.

My concern is - by the time I got the sample, he was peeing normally, and there was no (visible) blood like there was on Monday. I had begun to think the issue was stress induced cystitis (which was something the emergency vet mentioned as a possibility as well), as presumably if it was an infection the blood wouldn't clear up on its own. He absolutely hates vets, and when he was a kitten he had to get cystocentesis daily for weeks (by the end under daily anaesthesia). His bladder almost did not recover from the blockage damage he had then. We have avoided such procedures, including catheterization, since then at the advice of his specialist vet (who is no longer at the hospital). The specialist originally advised doing as little to him as possible, but I don't think she was completely against cystocentesis if needed - she had mentioned it very briefly a couple of times when I had issues getting a sample myself, but we never had to do it. It's been about 2.5-3 years since this happened.

I am now worried because I am causing him a lot more stress by dragging him to the vet again (plus we already have an appointment with a feline specialist at the same hospital on October 3). I am also causing potentially even MORE stress by agreeing to cystocentesis (which I know he'll probably struggle and be miserable during). And if it was cystitis, this could not only cause another flareup but the cystocentesis could further compromise his bladder.

On the other hand if I don't bring him in this week and the white blood cells do indicate an actual infection, I am worried that just leaving him be and not doing cystocentesis will cause the infection to progress and get worse. I have asked the vet if there was any way to give him any mild "preventative" medication to possibly treat infection when we're not certain, but was told this isn't an option.

His other symptoms include: vomiting twice (although here I suspect a hairball..) and low appetite. His appetite never recovered after he was sick those years ago, and this low appetite seems consistent with that, yet these symptoms are here. Behaviourally he seems fine - tail up, acting normal, peeing - much better than the state last Monday.

So my options are:

• Wait until we see the feline specialist on October 3 at the risk of him getting worse if it IS infection (and potentially rush him to hospital if so).
• Take him in on Wednesday (and then also October 3), potentially do the cystocentesis procedure to rule out infection for sure, but at the risk of side effects from stress and the intrusive procedure.

I am sort of leaning towards option 1 - because if it was an infection, it seems like the blood would be less likely to clear up on its own...but I am not sure? The cost here isn't a factor, but I'm very worried about putting him through more trips and procedures and potentially making him worse. Has anyone had to make this kind of choice before, what would you do? Is there anything else I should take into consideration?

Thank you

 

[Furballsmom]

Hi!
Have you tried any calming products? There are a lot on the market now with ingredients like casein, tryptophan, valerian, chamomile...people are also using CBD oil. --just be sure it's not hemp oil being sold as CBD oil.

Is your baby getting filtered water?

This kind of choice is so difficult, my heart goes out to you.

 

[stephanietx]

Have you tried supplements to help his urinary issues? I know several owners with urinary tract kitties and they use cornsilk and D-Mannose to help with e. coli infections in the bladder and urinary tract.

 

[lazer]

Hi all,

Yes we have tried and do use supplements and have tried many over the years - both calming and for urinary issues. The main thing I am wondering about with this thread is any feedback on the two choices now presented to me. Supplements are definitely important to consider, but short of CBD oil (which I am looking into trying as well but that won't be within the time span I need to make this choice) I don't have much more to try on that front. It's more like I need to make a decision between taking him in tomorrow or waiting.

Thank you!!

 

[white shadow]

.
I'm sorry that the whole purpose of your posting got ignored back there.

Putting myself in your shoes, I would want to know whether/not there's infection at play. My experience with cystocentesis has been no big deal - yes, I hear you about his stressing - but, the procedure itself, once he's sedated (that's not anesthesia) is a breeze.

There are two things that I'd urge you to discuss with the feline specialist:

• using Metacam in a cat with restricted urination. To me, that's a huge no-no, because of potential damage to the kidneys. This drug (and other non-steroidal anti-inflammatories or NSAIDs) have a narrow margin of safety in cats. [Cats' livers cannot metabolize it, so it circulates until it's excreted by the kidneys...meantime it's "nephrotoxic", destroying kidney tissue.] Again, please discuss it with that specialist.
  
• a management plan for his vet visits stress. There are meds that can be given at home to prevent his stressing out. I'll give you some links below...one is for the specialist Vet. Now, he will also pick up on your own stress level, so you are going to have to work on that, too. Knowing that his is being managed should help you with your own. (I'm not blaming you whatsoever, it's perfectly normal and understandable. My own tend to go through the roof!)

OK, some (stress prevention) links then:

For the Vet: http://vetanesthesiaspecialists.com...ionOptions_Feline_ABVP2015_HeidiLShafford.pdf

For you, a couple: Introducing Gabapentin: Gentle Sedation For Fearful And Aggressive Cats - Boston Street Animal Hospital and Study: Gabapentin Reduces Stress in Cats Before Veterinary Visits Both of those use one particular drug - other options are available.

Hope that's helpful.
.

 

[lazer]

.
I'm sorry that the whole purpose of your posting got ignored back there.

Putting myself in your shoes, I would want to know whether/not there's infection at play. My experience with cystocentesis has been no big deal - yes, I hear you about his stressing - but, the procedure itself, once he's sedated (that's not anesthesia) is a breeze.

There are two things that I'd urge you to discuss with the feline specialist:

• using Metacam in a cat with restricted urination. To me, that's a huge no-no, because of potential damage to the kidneys. This drug (and other non-steroidal anti-inflammatories or NSAIDs) have a narrow margin of safety in cats. [Cats' livers cannot metabolize it, so it circulates until it's excreted by the kidneys...meantime it's "nephrotoxic", destroying kidney tissue.] Again, please discuss it with that specialist.
  
• a management plan for his vet visits stress. There are meds that can be given at home to prevent his stressing out. I'll give you some links below...one is for the specialist Vet. Now, he will also pick up on your own stress level, so you are going to have to work on that, too. Knowing that his is being managed should help you with your own. (I'm not blaming you whatsoever, it's perfectly normal and understandable. My own tend to go through the roof!)

OK, some (stress prevention) links then:

For the Vet: http://vetanesthesiaspecialists.com...ionOptions_Feline_ABVP2015_HeidiLShafford.pdf

For you, a couple: Introducing Gabapentin: Gentle Sedation For Fearful And Aggressive Cats - Boston Street Animal Hospital and Study: Gabapentin Reduces Stress in Cats Before Veterinary Visits Both of those use one particular drug - other options are available.

Hope that's helpful.
.

Thank you, this was indeed very helpful. I'm now extremely worried about the metacam - he was only on it for five days but has been on it several times from the time these problems started. Unfortunately when I tried to get the vets to prescribe a different anti-inflammatory and pain relief drug a few years ago (having read that metacam may be dangerous), they said metacam was the only option. Metacam is also prescribed very often by vets to treat cats at the shelter I volunteer at, so over time I thought maybe it wasn't as scary a drug as I originally thought. Now I am again not sure..I'm definitely going to ask the specialist about the use of metacam and any alternatives, for the future, and am now scared that I have been slowly destroying his kidneys each time they prescribe it. I do tend to *under* dose on the metacam a bit. Is there a build-up of kidney damage with each use, or is it more like a risk of acute failure each time we use it (ie, if he is ok after this last course, does that mean he is "safe", or is some damage likely already done?)

I will definitely check out the sedation info you sent when I get home tonight; he doesn't seem TOO bad in that he does not mind being in the car at all, it is when we are actually in the room with the vet. He used to tolerate it so well but now each time we go he gets more and more upset.

In the meantime, this morning we discussed various options with the vet over the phone (before your reply), and I think it's a reasonable compromise for the time being. I realized that the urine test they did was not a culture, which is what they had done in the past to test him for infection. They just looked under the microscope and saw red and white blood cells, but those could be associated with any kind of inflammation (which we already knew he had). Even though their policy is usually to use cystocentesis when doing a culture to minimize risk of external contamination, with this particular cat they've always chosen to risk a non completely sterile sample over the more intrusive procedure. They agreed to once again do a culture this way, with strict conditions that it is to be brought in between certain times (when the lab is open) and within 30 minutes of the sample being collected. So my mission tomorrow will be to stay home and try to get a good sample.

Thanks again for the very useful info! I'm going to try not not freak out about the metacam...

 

[Furballsmom]

Hi! I don't think that the original question/comment was ignored. I, however, deliberately did not answer it directly.

In my case, I am not a vet so I don't feel qualified to say "I'd do this" because many situations, people and cats are so different, and especially with more complicated issues as are here. When additional comments are made that vet visits are hugely stressful to the cat, my initial/knee jerk reaction is try and not go because I'm dealing with THAT in my household, calming products and meds notwithstanding, plus many owners do not want to drug their cat.

In any case, in some situations "don't go" is obviously the exact wrong thing to say. On the other hand I'm not going to suggest to go, either, unless it's obviously necessary.

To the OP, I'm glad you feel like the path in front of you has been cleared, although I think you're not giving yourself enough credit. You're stronger than you think.

 

[Furballsmom]

Regarding Metacam, short term use may cause stomach ulcers, long term high dosages may cause major kidney issues. It should be given on a full tummy.

 

[white shadow]

....... Metacam is also prescribed very often by vets to treat cats at the shelter I volunteer at, so over time I thought maybe it wasn't as scary a drug as I originally thought.

Where, very generally, are you located, lazer?

Is there a build-up of kidney damage with each use, or is it more like a risk of acute failure each time we use it (ie, if he is ok after this last course, does that mean he is "safe", or is some damage likely already done?)

You 'hit the nail on the head' when you mentioned damage already done. The particular kidney tissue responsible for filtering the blood can not regenerate. Once it dies, it's gone forever. This makes it somewhat unique and different from, for example liver tissue/cells. We see this in humans...people with liver disease resulting from alcohol use can eventually recover full liver function over time as the liver cells regenerate. People with kidney 'failure' (really a misnomen, 'insufficiency' would be more appropriate), however, can never recover that lost function (unless by transplantation).

A section from a reliable website explains all this very well: (CKD=chronic kidney disease)

Why CKD Cannot Normally Be Detected at an Early Stage

I often hear from people who are kicking themselves for not realising sooner that their cat was sick. But it is actually normal for CKD not to be diagnosed until at least 66% of function has been lost.

A cat’s kidneys contain around 170,000 - 190,000 nephrons. This is actually many more nephrons than are needed for normal function; plus nephrons can increase their individual function to some extent when other nephrons die. This is why people can donate a kidney and still manage perfectly well with one kidney. In the case of a kidney transplant, if you remove one kidney from the donor, the donor's GFR (glomerular filtration rate, a measure of kidney function) will immediately fall to half of what it was, but will then gradually improve as the remaining nephrons increase their function to compensate for the loss of one kidney. Eventually the nephrons in the remaining kidney will reach almost the same level of function as two kidneys.

It works in a similar way in a cat with kidney disease, i.e. as damaged nephrons die (they are often described as "scar tissue"), other nephrons take over their work. Eventually, however, all the remaining nephrons will be working fulltime (i.e. there will be no renal reserve left). It is at this point, when around 66-75% of function has gone, that you will probably start to see symptoms in your cat, as the remaining nephrons start finding it harder to cope with the workload.
LINK: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - What Happens in CKD
​

I believe it would be wise to seek alternatives to NSAIDs and I'll be interested in hearing this specialist's response to you. I wonder if a steroid might be feasible. And, there is increased use of CBD oil generally, though I don't know/haven't read of its effects on/in urinary tract conditions. There are a couple of members here with informed experience and opinion on its use for other conditions. I'll give you a thread where its use is discussed...read the first post to get a sense of the problem, then read those posts by Kieka and daftcat75: here

I'll also leave you with an article on feline urinary disease by a well known holistic Veterinarian which may be helpful as foundational/background information. It's a bit 'wordy', but in plain English: Cat Urinary Tract Diseases: Cystitis, Urethral Obstruction, Urinary Tract Infection
.

 

[Furballsmom]

With all that said, I'm still going to maintain that there is no way to know if damage has actually occurred.
However, my posts here are obviously just an exercise in typing, which I'm very good at so I will exit stage left.
I'm sending all the best healing thoughts and wishes for your cat.