UTI and/or Stones in Older Kitty - too old for surgery :(

[kittygirl123]

Rescue is 17+ not sure of age but she is on prednisolone for IBD and a long history of diarrhea.
Last month discovered a lot of blood in urine. Resolved in a few days on antibiotics but blood is back. Her diarrhea is also back and intermittent and particular foul smelling, unusually foul.
Vet said since blood is back in urine it could be stones or even a tumor but she is too old for anesthesia and surgery "if"it is one of the two.
Are there alternatives if this is the case?

I had posted previously about her hind leg weakness and can't help but wonder if related.
All of her other labs WBC/RBC, renal values, thyroid, diabetes etc etc were all normal last month.
Thank you so much

 

[silent meowlook]

Hi.
I am so sorry about your kitty. I think maybe 17 is too old for your veterinarian, not your cat. I would think that it is worth finding out what is going on with the bladder. I wouldn't recommend they do a cystocentesis just in case it is a tumor. A cystocentesis aka cysto is where they extract urine from the bladder with a needle. But to get a sample instead you can collect it at home with a special cat litter. An abdominal radiograph would show if there are stones in the bladder and the urinalysis should give them an idea of what kind. Sometimes if the stones are small enough a diet change can dissolve the stones. Struvite stones can be dissolved, Calcium oxalate cannot. Struvite are far more common in cats.

All this being said, if your veterinarian isn't on board with treatment and thinks it is the end of the rope for your cat, it might be time to get a second opinion. I don't know where you are located but you might want to look into a feline only veterinarian. They can be very helpful because they focus only on cats and usually have much better insight into cat issues. If you cannot find one in your area, you might want to look for a referral to an internal medicine veterinarian if you want to pursue further treatment for your cat.

Only you know what is feasible for you and your cat. Yes, 17 is getting up there in cat years, but you may be able to make your cat feel better for the next couple of years. There just isn't any way of knowing without further diagnostics to come up with a diagnosis. Or sometimes you just treat the symptoms and see if it works.

 

[FeebysOwner]

Hi. I agree with all of the above. I do want to add a few things. Given the blood is back in the urine, it is possible that the antibiotic your vet prescribed was either not the correct one or wasn't given long enough to eradicate an infection, if that is what is going on. Only a urinalysis and a urine culture will help to not only identify the specific bacteria involved but distinguish - as mentioned above - if there are any stones/crystals and what type they are. These tests will also tell you other information about what is in the urine, which could also help with a better diagnosis.

As far as collecting urine at home, you need a kit to do so, such as this one: Amazon.com : KIT4CAT 2lb Hydrophobic Cat Litter for Urine Collection, Hydrophobic Sand Urine Collection Litter Kit I Collect cat Urine Sample for Test (3 x 11oz Bags) : Pet Litter : Pet Supplies. Some vets have kits in their offices, so you could check on that as well.

Many cats who have diarrhea, including those with IBD use a probiotic to help firm up the stools; s. boulardii is a very common one. The brand I see most often referred to is Jarrow.
The benefits of using S. Boulardii for cats– FullBucket Health
Amazon.com: Jarrow Formulas Saccharomyces Boulardii + MOS - 5 Billion CFU Per Serving - Probiotics + Prebiotic Supplement - Intestinal Tract Support - Up to 90 Servings (Delayed Release Caps) (PACKAGING MAY VARY) : Health & Household
It wouldn't hurt to have a full-scale fecal PCR done too. You can collect stool on your own and take it to the vet for testing. If you can't take it in right away, you can keep it refrigerated for many hours in order to maintain its viability.

I don't know if all of your cat's conditions are related or not, but that is where an internal med specialist would come in handy as they can assess all the issues together. I know you said in your other thread that your vet doesn't have much faith in specialists - but sometimes they are necessary - and that is a very harsh blanket statement to be made by your vet, IMO.

 

[kittygirl123]

Hi. I agree with all of the above. I do want to add a few things. Given the blood is back in the urine, it is possible that the antibiotic your vet prescribed was either not the correct one or wasn't given long enough to eradicate an infection, if that is what is going on. Only a urinalysis and a urine culture will help to not only identify the specific bacteria involved but distinguish - as mentioned above - if there are any stones/crystals and what type they are. These tests will also tell you other information about what is in the urine, which could also help with a better diagnosis.

As far as collecting urine at home, you need a kit to do so, such as this one: Amazon.com : KIT4CAT 2lb Hydrophobic Cat Litter for Urine Collection, Hydrophobic Sand Urine Collection Litter Kit I Collect cat Urine Sample for Test (3 x 11oz Bags) : Pet Litter : Pet Supplies. Some vets have kits in their offices, so you could check on that as well.

Many cats who have diarrhea, including those with IBD use a probiotic to help firm up the stools; s. boulardii is a very common one. The brand I see most often referred to is Jarrow.
The benefits of using S. Boulardii for cats– FullBucket Health
Amazon.com: Jarrow Formulas Saccharomyces Boulardii + MOS - 5 Billion CFU Per Serving - Probiotics + Prebiotic Supplement - Intestinal Tract Support - Up to 90 Servings (Delayed Release Caps) (PACKAGING MAY VARY) : Health & Household
It wouldn't hurt to have a full-scale fecal PCR done too. You can collect stool on your own and take it to the vet for testing. If you can't take it in right away, you can keep it refrigerated for many hours in order to maintain its viability.

I don't know if all of your cat's conditions are related or not, but that is where an internal med specialist would come in handy as they can assess all the issues together. I know you said in your other thread that your vet doesn't have much faith in specialists - but sometimes they are necessary - and that is a very harsh blanket statement to be made by your vet, IMO.

Thank you so much.
A culture was done initially to ensure it was the right antibiotic, but for some reason the blood persists which is why I am worried it could be stones or is it possible the course of meds wasn't long enough?

I will get her a probiotic, i used to give her one but even the slightest anything in her food and she won't eat it. The most finicky eater I have ever had. She only eats wet food and just 2 brands and getting meds in her is a nightmare so if it's not in her wet food we cannot medicate her. I have had now 10 cats and she is a wild banshee, i never had issues getting pills in like this one even wrapped in a towel her head is SO strong and fast
Thank you

 

[kittygirl123]

Hi.
I am so sorry about your kitty. I think maybe 17 is too old for your veterinarian, not your cat. I would think that it is worth finding out what is going on with the bladder. I wouldn't recommend they do a cystocentesis just in case it is a tumor. A cystocentesis aka cysto is where they extract urine from the bladder with a needle. But to get a sample instead you can collect it at home with a special cat litter. An abdominal radiograph would show if there are stones in the bladder and the urinalysis should give them an idea of what kind. Sometimes if the stones are small enough a diet change can dissolve the stones. Struvite stones can be dissolved, Calcium oxalate cannot. Struvite are far more common in cats.

All this being said, if your veterinarian isn't on board with treatment and thinks it is the end of the rope for your cat, it might be time to get a second opinion. I don't know where you are located but you might want to look into a feline only veterinarian. They can be very helpful because they focus only on cats and usually have much better insight into cat issues. If you cannot find one in your area, you might want to look for a referral to an internal medicine veterinarian if you want to pursue further treatment for your cat.

Only you know what is feasible for you and your cat. Yes, 17 is getting up there in cat years, but you may be able to make your cat feel better for the next couple of years. There just isn't any way of knowing without further diagnostics to come up with a diagnosis. Or sometimes you just treat the symptoms and see if it works.

Great info thank you. Would not have known about the risk of the needle extraction so I am glad that failed them last time.

I do have a cat only vet locally but she overlooked issues previously and pushed so many tests. Some are more sales people than anything and it is so disturbing. I love my vet, she has 5 cats and tries to do the least amount of testing/stress unless indicated but I just made an appt for Tues to see if she wants to do an x ray and examine her hind leg issue. The good news is she is not losing weight.

I do have metronidazole here for the diarrhea just not sure if needs an entire course. Thanks much

 

[FeebysOwner]

A culture was done initially to ensure it was the right antibiotic, but for some reason the blood persists which is why I am worried it could be stones or is it possible the course of meds wasn't long enough?

If they did a urine culture, then they also did a urinalysis, and that should have indicated whether or not there was sediment in the urine, which could mean stones or crystals. Ask your vet about that.

Would not have known about the risk of the needle extraction so I am glad that failed them last time.

A cystocentesis would only be an issue if the vet thinks there is a mass in her bladder, otherwise, it is the best, most sterile way to collect urine. But, if they did a urine culture before, then they must have already collected urine at that time, in some manner. So, should another urinalysis/culture be needed, the vet can handle it in the same way as before. Also, if they do an x-ray, it would likely show up any kind of mass - as well as stones/crystals.

I will get her a probiotic

I specifically mentioned s. boulardii as it is yeast based which means it can be used in conjunction with antibiotics. Many other types of probiotics, which are bacterial based, are rendered less effective when used at the same time as an antibiotic. I am not sure what it tastes like, but you can at least give it a try. Have you tried lickable treats, pill pockets, or pill masker for administering any meds/supplements to your cat?

Metronidazole is an antibiotic/antiprozoal med, so while it can be used to help with diarrhea, it might not be the best choice at this time unless something would show up in fecal test to indicate an intestinal inflammation/infection and/or parasites. Also, most antibiotics require consistent use for a prescribed period of time; not giving an entire course is usually not recommended.

I hope your kitty does OK with the vet visit, and any testing the vet will agree to do!! Keep us posted!

 

[kittygirl123]

If they did a urine culture, then they also did a urinalysis, and that should have indicated whether or not there was sediment in the urine, which could mean stones or crystals. Ask your vet about that.

A cystocentesis would only be an issue if the vet thinks there is a mass in her bladder, otherwise, it is the best, most sterile way to collect urine. But, if they did a urine culture before, then they must have already collected urine at that time, in some manner. So, should another urinalysis/culture be needed, the vet can handle it in the same way as before. Also, if they do an x-ray, it would likely show up any kind of mass - as well as stones/crystals.


I specifically mentioned s. boulardii as it is yeast based which means it can be used in conjunction with antibiotics. Many other types of probiotics, which are bacterial based, are rendered less effective when used at the same time as an antibiotic. I am not sure what it tastes like, but you can at least give it a try. Have you tried lickable treats, pill pockets, or pill masker for administering any meds/supplements to your cat?

Metronidazole is an antibiotic/antiprozoal med, so while it can be used to help with diarrhea, it might not be the best choice at this time unless something would show up in fecal test to indicate an intestinal inflammation/infection and/or parasites. Also, most antibiotics require consistent use for a prescribed period of time; not giving an entire course is usually not recommended.

I hope your kitty does OK with the vet visit, and any testing the vet will agree to do!! Keep us posted!

So helpful thank you!
I collected the urine initially for the culture myself - i put a cup under her and she let me but she is now not a fan.
It was clean, nothing in it but red/so bloody. I have never had a kitty not show me when they had an infection somehow so it broke my heart to not know how long it was going on. But yes they sent it out for culture and did not say anything about crystals but i will certainly ask. Great idea.

I ordered the amazon Jarrow brand and it will be here tonight, so happy about that. And good to know on the metronidazole, I remember just using it as a dose here and there on a kitty once but I guess that doesn't make sense if an antibiotic so I wonder why. Hmmm.
She has an appt. Tuesday afternoon so I will report back. May take an Xray at that time as she has awful hind leg weakness too. Not arthritis as she still jumps and such but she sort of stumbles to the side when first wakes up. Could be inner ear but we will check.

 

[FeebysOwner]

It was clean, nothing in it but red/so bloody. I have never had a kitty not show me when they had an infection somehow so it broke my heart to not know how long it was going on. But yes they sent it out for culture and did not say anything about crystals but i will certainly ask.

You wouldn't likely be able to actually see sediment in the urine - that is what the urinalysis is for. My cat, who was prone to UTIs for a while, hardly ever showed signs that she had one, so I just made sure she had routine urinalyses done, and cultures if there were bacteria in the urine from the results of the urinalyses.

You can also look into pee strips that you can use to check your cat's urine at home, but if she is no longer cooperating with you catching the urine, this might not be an option. I could never have done this with my cat!
CHECKUP UTI Detection for Pets Urine Testing for Dogs & Cats, 50 strips - Chewy.com

 

[kittygirl123]

You wouldn't likely be able to actually see sediment in the urine - that is what the urinalysis is for. My cat, who was prone to UTIs for a while, hardly ever showed signs that she had one, so I just made sure she had routine urinalyses done, and cultures if there were bacteria in the urine from the results of the urinalyses.

You can also look into pee strips that you can use to check your cat's urine at home, but if she is no longer cooperating with you catching the urine, this might not be an option. I could never have done this with my cat!
CHECKUP UTI Detection for Pets Urine Testing for Dogs & Cats, 50 strips - Chewy.com

Haha yeah I have done it will all my kitties, just cup under them but this one is the most finicky eater, medication taker, and now cup pee'er. She is soooo difficult and also SO tiny and SO vocal she has to be part siamese.

I will definitely try the strips. So I presume if they did the culture they didn't do a urinalysis? Or at same time is common?

 

[FeebysOwner]

So I presume if they did the culture they didn't do a urinalysis? Or at same time is common?

The 'norm' that I know, is do the urinalysis first, look for various things (e.g., sediment) as well as bacteria. If there are bacteria, then it is followed up with a urine culture to determine what kind of bacteria are involved in order to identify the most effective antibiotics. If the urinalysis shows no bacteria, there really isn't much value in following up with a culture. I have never known a vet to do a urine culture without a urinalysis being done first.

 

[kittygirl123]

The 'norm' that I know, is do the urinalysis first, look for various things (e.g., sediment) as well as bacteria. If there are bacteria, then it is followed up with a urine culture to determine what kind of bacteria are involved in order to identify the most effective antibiotics. If the urinalysis shows no bacteria, there really isn't much value in following up with a culture. I have never known a vet to do a urine culture without a urinalysis being done first.

I think she was looking for diabetes? I was surprised by that myself because it was always done in house but this time she said to send out for culture and it cost A LOT more like $50 for the culture alone.
Would diabetes test make sense? Still think that can be done in house from urine if sugars are present but I don't know. So I am stumped.

 

[FeebysOwner]

Blood work, specifically included as part of the Chemistry panel, can help to identify diabetes through the glucose reading - not just seeing sugar (glucose) in the urine. I am not aware of a urine culture having anything to do with checking further for diabetes. The urine culture is traditionally done to 'culture' bacteria found in a urinalysis to see what grows in order to identify what the bacterium is.

 

[silent meowlook]

The urine culture is because if the urine has glucose it becomes the perfect breeding ground for bacteria. There is actually an in-house culture that can be used by vets at the hospital called a uricult. The urine is cultured in a special tube and will show if there is bacteria and what type within 24 hours. It tests for the basics and if further identification is needed the tube can be sent to the lab for identification. It’s only been out about 5 years if that.
There are good and bad with all vets. I’ve seen useless uncaring specialists and also very good ones. It’s hard to find a good vet sometimes or one you feel you can trust. It sounds like you trust your current vet, so that is good. I would stick with her then. But if she doesn't feel comfortable doing anesthesia on a senior kitty, there may be a reason. I don't know that I would put a cat that age with those issues under anesthesia either. It is never without risk.

What ever you do, I hope everything works out .

The weakness you describe in the hind end can be caused by a spinal cord problem, or many other things. An xray might at least rule some things out.

 

[Kat Luv]

Hi there K kittygirl123 , looks like you have lots of good advice here, especially with respect the the renal/bladder issues. I 100% agree with the above posts. I have a 17 yo cat with pancreatitis, hyperthyroid, and a couple of other issues that recur. At one point, we were told she was starting renal failure- however her lab values (renal function) are now back in their respective normal ranges.

I am curious- have they tested your cat for pancreatitis (the lab test is called FPL) ? Mine has had everything from severe constipation to diarrhea, and at different points in time, the diarrhea caused her UTIs and blood (dark) in her stool. She now takes prednisolone every other day for 10 doses at a time, only during flares.

Other than getting tested for pancreatitis, I'd look into the prednisolone (I noticed you mentioned that your cat has been on prednisolone for a while for IBD). Prednisolone, along with other corticosteroids, definitely can cause internal bleeding, and very well may be the cause of both the GI bleed and the urinary bleed. If the cat has been on prednisolone for more than a month, I'd definitely ask your vet and perhaps another highly recommended vet for cats in your area about this as the cause.

Best wishes getting your sweet girl feeling better soon.

 

[kittygirl123]

Hi there K kittygirl123 , looks like you have lots of good advice here, especially with respect the the renal/bladder issues. I 100% agree with the above posts. I have a 17 yo cat with pancreatitis, hyperthyroid, and a couple of other issues that recur. At one point, we were told she was starting renal failure- however her lab values (renal function) are now back in their respective normal ranges.

I am curious- have they tested your cat for pancreatitis (the lab test is called FPL) ? Mine has had everything from severe constipation to diarrhea, and at different points in time, the diarrhea caused her UTIs and blood (dark) in her stool. She now takes prednisolone every other day for 10 doses at a time, only during flares.

Other than getting tested for pancreatitis, I'd look into the prednisolone (I noticed you mentioned that your cat has been on prednisolone for a while for IBD). Prednisolone, along with other corticosteroids, definitely can cause internal bleeding, and very well may be the cause of both the GI bleed and the urinary bleed. If the cat has been on prednisolone for more than a month, I'd definitely ask your vet and perhaps another highly recommended vet for cats in your area about this as the cause.

Best wishes getting your sweet girl feeling better soon.

How interesting, never any suggestion for pancreatitis. I will ask tomorrow. She never had constipation but since we rescued her years and years of black diarrhea (bloody) so she takes daily pred. I know you have to titrate down but if wondering if going to every other day (5mg) will be safe as a "trial",as I hate the idea of her on long term. she is just a 7 pound girl and could be 17 or 18 now, not sure, maybe older.
Had NO IDEA could cause the urinary bleed, but the GI existed ages before.
Sadly other vets in the area have lost their integrity and want to sell tests and care little about cats that is why this office is so busy.
Thanks so much, we see her tomorrow.
Other kitty also 18 or so, on steroid and thyroid but been great for a while. Youngest at 12'ish was $1300 at an ER vet due to vomiting. They had NO answers just put her through so much and she was fine 2 days later. SO upsetting. My vet saw all they did and said "she did not need X rays AFTER your $550 ultrasound or all those labs" learned the hard way.

 

[FeebysOwner]

Prednisolone might be able to be replaced with Budesonide - it focuses more on the GI tract and tends to have less impact on the heart and reduces the risk of diabetes. I don't know about the 'bleeding' aspect.

 

[Kat Luv]

How interesting, never any suggestion for pancreatitis. I will ask tomorrow. She never had constipation but since we rescued her years and years of black diarrhea (bloody) so she takes daily pred. I know you have to titrate down but if wondering if going to every other day (5mg) will be safe as a "trial",as I hate the idea of her on long term. she is just a 7 pound girl and could be 17 or 18 now, not sure, maybe older.
Had NO IDEA could cause the urinary bleed, but the GI existed ages before.
Sadly other vets in the area have lost their integrity and want to sell tests and care little about cats that is why this office is so busy.
Thanks so much, we see her tomorrow.
Other kitty also 18 or so, on steroid and thyroid but been great for a while. Youngest at 12'ish was $1300 at an ER vet due to vomiting. They had NO answers just put her through so much and she was fine 2 days later. SO upsetting. My vet saw all they did and said "she did not need X rays AFTER your $550 ultrasound or all those labs" learned the hard way.

Hi K kittygirl123 ! I feel for you, having to wait due to the lack of quality vets. I was having to drive 35 miles one way where we used to live, as there were no good vets nearby. I hope you can get definitive answers, and I'd ask the vet how to taper off if that's the course of action. I'd definitely recommend the FPL blood test, just to know if it's in range or looking like possible pancreatitis.
I am nearly certain that another cat I had in the 90s had pancreatitis too, but at that time I don't think as many vets tested for/looked for it. In fact, it took me 3 vets with my current kitty to get it confirmed. We found a really, really good cats only clinic and the vet is phenomenal. I am so grateful for her, though I feel like I am a handful for her (I have one senior kitty on 5 prescription meds/prescription diet/subq fluids and another semi-feral lady with GI issues, 2 prescription meds, prescription diets and anxiety +pica). Seems there's never a dull moment at my house.

My little ladies may need to get work-from-home jobs soon to help with the bills...

 

[kittygirl123]

Hi K kittygirl123 ! I feel for you, having to wait due to the lack of quality vets. I was having to drive 35 miles one way where we used to live, as there were no good vets nearby. I hope you can get definitive answers, and I'd ask the vet how to taper off if that's the course of action. I'd definitely recommend the FPL blood test, just to know if it's in range or looking like possible pancreatitis.
I am nearly certain that another cat I had in the 90s had pancreatitis too, but at that time I don't think as many vets tested for/looked for it. In fact, it took me 3 vets with my current kitty to get it confirmed. We found a really, really good cats only clinic and the vet is phenomenal. I am so grateful for her, though I feel like I am a handful for her (I have one senior kitty on 5 prescription meds/prescription diet/subq fluids and another semi-feral lady with GI issues, 2 prescription meds, prescription diets and anxiety +pica). Seems there's never a dull moment at my house.

My little ladies may need to get work-from-home jobs soon to help with the bills...

Ugh so sorry it is so much!
I have 3 now, had 4 so I totally empathize. One had grand mal seizures for a bit that were so violent so this seems easy but still. And my other old girl has pica too, ugh they are a lot but worth it!

Just back from vet. Xray revealed gallstones which made me nervous but she said often insignificant and I would know if caused obstruction and not surgery she would put her through or any of her cats.
No bladder stones.
Did a cysto and as much blood as before she said may be coming from kidney so we are "hoping" that she just needs a longer course of antibiotics so we have 2 weeks now. She said she may need them long term which some of you said. But she has gained a bit of weight and all else is good (labs) so she said if she had an ultrasound not much would change likely.

She did send the urine out again to be sure nothing changed in terms of the med and we just have to keep retesting.
And of course I forgot mention that her stools are suddenly black and have the most foul odor ever. But I did get the recommended probiotic (yeast based) she is just not going for it so I can't get a full capsule in her but I presume less is ok?

Thanks much! Will update others.

 

[kittygirl123]

Prednisolone might be able to be replaced with Budesonide - it focuses more on the GI tract and tends to have less impact on the heart and reduces the risk of diabetes. I don't know about the 'bleeding' aspect.

Just back from vet. She said her dose is not even therapeutic so she would not change it, its' so minimal. Hmmm
Xray revealed gallstones which made me nervous but she said often insignificant and I would know if caused obstruction and not surgery she would put her through or any of her cats.
No bladder stones.
Did a cysto and as much blood as before she said may be coming from kidney so we are "hoping" that she just needs a longer course of antibiotics so we have 2 weeks now. She said she may need them long term which some of you said. But she has gained a bit of weight and all else is good (labs) so she said if she had an ultrasound not much would change likely.

She did send the urine out again to be sure nothing changed in terms of the med and we just have to keep retesting.
And of course I forgot mention that her stools are suddenly black and have the most foul odor ever. But I did get the recommended probiotic (yeast based) she is just not going for it so I can't get a full capsule in her but I presume less is ok?

Thanks much! Will update others.

 

[kittygirl123]

The urine culture is because if the urine has glucose it becomes the perfect breeding ground for bacteria. There is actually an in-house culture that can be used by vets at the hospital called a uricult. The urine is cultured in a special tube and will show if there is bacteria and what type within 24 hours. It tests for the basics and if further identification is needed the tube can be sent to the lab for identification. It’s only been out about 5 years if that.
There are good and bad with all vets. I’ve seen useless uncaring specialists and also very good ones. It’s hard to find a good vet sometimes or one you feel you can trust. It sounds like you trust your current vet, so that is good. I would stick with her then. But if she doesn't feel comfortable doing anesthesia on a senior kitty, there may be a reason. I don't know that I would put a cat that age with those issues under anesthesia either. It is never without risk.

What ever you do, I hope everything works out .

The weakness you describe in the hind end can be caused by a spinal cord problem, or many other things. An xray might at least rule some things out.

Just back from vet.
Xray revealed gallstones which made me nervous but she said often insignificant and I would know if caused obstruction and not surgery she would put her through or any of her cats.
No bladder stones.
Did a cysto and as much blood as before she said may be coming from kidney so we are "hoping" that she just needs a longer course of antibiotics so we have 2 weeks now. She said she may need them long term which some of you said. But she has gained a bit of weight and all else is good (labs) so she said if she had an ultrasound not much would change likely.

She did send the urine out again to be sure nothing changed in terms of the med and we just have to keep retesting.
And of course I forgot mention that her stools are suddenly black and have the most foul odor ever. But I did get the recommended probiotic (yeast based) she is just not going for it so I can't get a full capsule in her but I presume less is ok?

Thanks much! Will update others.