first time dealing with crystals

[sylorna]

Hi guys

I just found out that Dynah has bladder crystals.  I took her to a new vet (so far they've been great) and I just wanted to run what's happened by you guys to make sure everything is going as expected.

I took her in this morning to do a urine analysis and some blood work and left her there.  The vet said she could not feel Dynah's bladder (turns out it's very small) and did an ultrasound.  She said she found 3-4 crystals and some fragments in the base of her bladder.  She also said that her bladder is very irritated and the walls are dense as a result.  The blood work came up normal.

The plan right now is to get a urine sample (if she'll pee for them) to figure out what kind of crystals she has.  The vet said that there are two kinds:  One kind that dissolves and one kind that does not.  Given that most cats have the dissolvable kind, she is giving Dynah:

Antibiotics

Pain meds for the bladder

and a wet food diet that is for breaking down the crystals.

She would like to reassess in 4 weeks with an ultrasound to see where the crystals are at.  If they are not dissolvable, she said that it will cost $1800 for the surgery.

It all sounds like reasonable measures right now.  Does this all make sense?

 

[denice]

It does make sense.  Hopefully they will be able to get a urine sample.  If the pH is too low then the crystals are oxalate, if it's too high then they are struvite,.  The vast majority of the time they used to be struvite crystals but that has changed recently.  Many companies started adding an acidifier to their foods usually dl-methionine to combat struvite crystals which has caused a rise in oxalate crystals.  The oxalate crystals are more difficult to treat.

It would also tell you if there is an infection present.

 

[sylorna]

Ok, I thought that's what was going on.  Her bladder is small enough that the needle extraction of urine will be difficult (especially because she's a difficult patient).  Keep your fingers crossed we don't need surgery.

 

[rlavach]

Yes, they do. Those are basically the steps that we've taken with my 2 cats with crystals. 1 was able to be dissolved with food (struvite), the other actually had stones instead of crystals. We tried the food with her for 1 month & it didn't work, so they had to do surgery to remove the stones. They're both doing well now. Hope you kitty feels better soon! 

 

[Columbine]

Makes sense to me too. Struvite crystals are still the most common sort (what denice says about the rise of oxalate crystals is correct though). I hope they can get a urine sample though - it makes it easier to determine appropriate treatment. In my mind, it's really worth knowing if antibiotics are necessary. If it turns out they're not needed it's one less medication to get into her.

In addition to the prescription diet, it's well worth seeing if you can increase Dynah's fluid intake. The better hydrated she is the more dilute (and so less acidic) her urine will be. Less acid should mean less irritation, and the extra fluid will assist with flushing out the crystal fragments.

A great way to get her to drink more is to give her 'yummy' water. My guys all love the water left after poaching chicken. If you get tuna canned in spring water, the water from that is another drink cats seem to love.

These articles should help too :-
http://www.thecatsite.com/a/feline-lower-urinary-tract-disease-flutd
http://www.thecatsite.com/a/tips-to-increase-your-cat-s-water-intake
http://www.catinfo.org

 

[nansiludie]

Yes, seems reasonable, which type of RX food is she eating now? I agree with Columbine, increasing the water intake along with the diet to dissolve the crystals if they are the kind to be able to be dissolved, is a very good starting point. Another thing that may help with the water intake is getting a cat fountain, the kind that filters the water. 

 

[sylorna]

So just got back from the vets. She wouldn't give the urine and her bladder is too small for them to use a needle to extract it. We're trying the food route and have pain meds and antibiotics as well. She'll go in for another ultrasound in 4 weeks assuming she's still OK. They gave me royal canin so wet and she is wet only as of today.
I picked up a new fountain on my way home and will move the existing bowl to the bedroom.

 

[nansiludie]

Yes, keep feeding the wet food, it helps keep the system flushed. Hopefully she'll be doing well soon.

 

[lorelaibella]

Sometimes crystals are caused by too much protein in the diet andnot enough liquid. try homemade chicken broth over white rice. Or stage one or two baby food (meat kind)....helped my cat that lived 15 years.

 

[sylorna]

I'm having a bit of a bad moment right now. I just watched Dynah sit and sit in the pan... The pee was small That she produced. I'm giving her the antibiotics and she's still hungry (although she is refusing the vet wet I'm putting a tiny amount in with her regular wet and no dry). She is not lethargic or throwing up. I'm so scared though.

 

[sylorna]

Feeling a bit better after 2 cuddle sessions initiated loudly by her (as per normal fare).

 

[Columbine]

It's natural to be scared and worried, but try to relax a little. It sounds like you've got a great vet, and you're doing all the right things. Hang in there.

If she's really adamant that she won't eat the royal canin, see if you can try Hills or Purina instead.

 

[sylorna]

Mixing the royal canin isn't working very well. I think I'm going to try putting some tuna water in it later today.
She seems in better spirits this morning and woke me up for breakfast. I watched her pee and it was a quick trip followed by digging. I couldn't check size of clump because I didn't have a chance to empty it yet this morning. Maybe something passed or moved out of the way.
Thanks for the vibes. I really needed them last night.

 

[sylorna]

So the tuna really didn't work. She looked scared and ran away. She came out for the regular stuff though. Picked up 2 varieties of hills today. I hope she likes one of these better.
Also she peed right after a box change today and it was slightly bigger than yesterday. Maybe the extra fluid is helping?

 

[nansiludie]

Try very soupy turkey baby food poured over the rx food, the main thing is she must eat and she must have plenty of water going through her system. Be sure the baby food does not have any garlic or onion powder in it.

 

[sylorna]

Both hills rejected tonight. I have her locked in the bedroom with them for awhile. Hopefully she'll change her mind, but it's unlikely. Never tried baby food before. I'll consider it come Tuesday when the store's open again

 

[detmut]

Both hills rejected tonight. I have her locked in the bedroom with them for awhile. Hopefully she'll change her mind, but it's unlikely. Never tried baby food before. I'll consider it come Tuesday when the store's open again

well, you still have Purina rx to try. also, Friskies Special Diet and Purina Pro Plan Urinary over the counter. 

 

[sylorna]

I was just looking on the Purina site to see about a vet that carries their stuff and they don't have a bladder rx listed (they have one for maintenance but not for dissolving). Anyone know if they carry it in Canada? No luck with locking her in last night. I threw a hissy fit and now she's having a hard time trusting me (I yelled and stomped around). Didn't help that I had to pill her antibiotic last night because she kept on eating the treat and spitting the pill out. I'm feeding the old stuff with extra water in it and am slowly regaining trust. She also did not spit her pill out this morning. I wish she'd just eat!

 

[LTS3]

I was just looking on the Purina site to see about a vet that carries their stuff and they don't have a bladder rx listed (they have one for maintenance but not for dissolving). Anyone know if they carry it in Canada?

I don't think Purina makes a prescription food for urinary issues: https://www.purinaveterinarydiets.com/pet-food-nutrition/feline/products/

Iams does make prescription foods and there is one for urinary issues in cats: https://www.iamsvetformula.com/home.do The web site is apparently for vets only so here's the product info for the dry: http://www.chewy.com/cat/iams-veterinary-formula-urinary-s/dp/45553 and canned: http://www.chewy.com/cat/iams-veterinary-formula-urinary-s/dp/45560

 

[puck]

On abdominal ultrasound, your vet could see uroliths, then, bladder stones? Crystals are identified by urinalysis, seeing the individual crystals forming in urine upon close microscopy, as well as different types of white blood cells, any red blood cells, which are very common in cats with crystals or stones, as these formations cut into the bladder wall, causing bleeding.

Uroliths of either variety, be they struvites or calcium oxolate stones, may not be successfully dissolved with diet alone. And as this does take time, and the crystals are still accumulating, causing discomfort, bleeding, and inappropriate urination, many owners go ahead and opt for cystotomy, flushing the urethra of any smaller stones, and then feeding Rx urinary diet therapeutically after surgery.

Royal Canin has become the front runner in urinary diets. They have now generated the majority of their prescription feline diets with the S/O index, meaning even their dental, calm behavior, GI, and renal diets have the SO index to limit the accumulation of mineralized phosphorus and calcium, to maintain concentrated enough urine to limit bacteria, but not over-concentrated to permit crystal formation, and ideal pH, as close to 6-7.0 as possible.  If prone to stress induced cystitis, many cats do well on the Calm Rx diet by Royal Canin, even when added as treats, 5-6 pieces twice daily, as it has the S/O index and calming proteins that help relax mammals when anxious. A 7lb bag lasted me 1 month feeding as treats for 3 stressed cats when moving a lot and changing up the schedule led to those 3 not using their litterbox as often, or their water dishes as often. Only used with the Feliway after anxiolytic Rx's didn't help, for 6 mo after a move and burglary stressed the household out. RC developed it from their R+D dept in 2011, and all I needed was 1 free sample bag for feeding boarding cats back then and I was hooked! Your girl may benefit from it even as treats only, in addition to Feliway diffusers near litterboxes and dishes, especially as she adjusts to whatever stress trigger you may have noted in your environment or schedule.

Fortunately, the rest weren't stressed enough to get cystitis or "sludge" as I do have primarily studs and they were all neutered very young, a contributing factor by some researching vets' conclusions. But, they all love to argue those kind of points. I just work to prevent pee pee problems, as you can't change when they were teutered, that's done and gone.

Hill's still makes s/d and c/d. The s/d is the dissolution diet, and is very high fat, to compensate calorically for low protein. Patients gain gain gain weight on this, even when only used for 8 weeks to dissolve any uroliths (stones) already present in the bladder. For maintenance, cats are placed either on c/d, or on regular OTC wet diet only, the rest of their lives after the 8 weeks max on s/d; s/d is not a maintenance diet, and has its own problems it can cause if a cat is kept on it too long.

Purina makes UR, another diet with a struvite/oxolate index, so to speak. They thought of this index before Royal Canin, to be honest, but RC improved on their idea, and clinically, the Royal Canin SO has better success dissolving uroliths and maintaining patients prone to "sludge" and/or crystals (males), as well as idiopathic cystitis (females). The UR is a good option if the feline patient is averse to RC SO or canned in general.  Moisture alone, diuresing the bladder for days, can be enough to flush out struvites and limit their re-accumulation; then just maintaining higher water intake, with wet food, with flavoring water to increase thirst, etc often prevents any recurrence of struvite formation, let alone the crystals accumulating into a stone, layering until a little "glass rock" is formed.

Pain management for Dynah is great, as cats tend to tighten up and limit urination due to pain alone when they try to release their bladder or push with any pressure. Buprenorphine every 8 hours is the best. Also, consider corticosteroid treatment, as prednisolone helped many of my urolithiasis cats' bladder inflammation calm down enough to allow for better bladder expression and emptying, as well as decreasing inflammation of the muscles she's been over-working, straining, trying to empty more when she feels the fullness the uroliths and blood can add to urgency, to her "need to pee" impulse.

If you don't already, place multiple litterboxes with aforementioned Feliway diffusers nearby, throughout the home just in case she now prefers more privacy, or wants a more open area, conversely, as she may if she was pounced upon or startled while using the box sometime when all this started, causing her to decrease her "bathroom" use to avoid aggressive confrontation or anxiety, only to lead to over-concentrated urine that was pre-disposed to crystal formation, then urolith formation. I have many patients' litter preference, open/closed box preference, placement preference, and litter habits change before , during, and after cystitis with or without crystals or urethral obstructions. They are fine tuned to their home environment, as many of us know, much more easily influenced by an environmental change than dogs.

A side Note: This is why owners looking to get their "first pet" are cautioned by me, as they all assume a cat "is easier, better, as I don't have the time to give a dog attention, I'm gone alot, I travel alot, We're moving soon, etc"  Dogs have transitioned with truck drivers, business gurus, students, and new babies a lot easier than cats anectdotally, as they can go with owners on trips easier, they leave the house on leash often to explore the world that exists beyond their windows, and outdoors is their bathroom, not the living space they must share with other cats, dogs, people.

I and many roommates worried our potential cats wouldn't fare well with us moving a lot, inconsistent class and work schedules, summer work elsewhere then back home, lots of visitors for study sessions, parties, and weekends away at the coast or mountains. We opted for dogs first, and they handled all those changes well, as long as they still got their exercise, their busy treats and toys, and much professional training with each of us, knowing we all needed to learn how to communicate, as the dog had it down, and the people were just itching to catch up.

Good luck with lil Dynah and hope her pee pee problems resolve soon!