HT cat with urinary issues

elliebean

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Hi, all. I haven't looked at this forum since you all were kind enough to try to help me with my cat who died last year, but I figured I would ask for your advice again. I'm realizing that after dealing with his health issues and death, I have much more anxiety around my pets' health and am struggling with all this.

So, I have an almost 17 year old spayed female cat who I recently moved to a new state. She was diagnosed mid-March with hyperthyroidism (she had many tests and was cleared for kidney issues, liver issues, diabetes), and her T4 is already back in normal range after being on felimazole (currently lowered to 2.5mg/day). I then moved her from my mom's house to an apartment with my wife's 2 cats who are new to her, so when we started introducing them and she started peeing on the litter mats, we thought it was behavioral.

2 weeks ago though she would empty her bladder and then go back and forth to the litter boxes or mats or soft places and keep trying to pee, but since her bladder was emptied she was just straining and getting out drops. I thought it was a UTI, so I took her to the vet right away, and her urinalysis had occult blood (+10), urine protein (+100), leukocytes (+500), bacteria (occasional cocci), and high WBC ("too high to count"). It was negative for crystals. They said she wasn't blocked at all and that it was easy to get her to pee, and they prescribed her a 10-day course of Clavamox. She was quickly feeling better, still peeing on mats sometimes but no longer straining at all. The course ended Sunday (2 days ago), but I just saw her straining again after emptying her bladder earlier.

She's been through a lot of changes recently, and I don't know how much they could be contributing to this issue. She'd never had any health issue until now. I gave her dry food only her whole life, but starting about a year ago she was given a can of wet food daily and had free access to kibble. Since moving her in March, though, she's back to dry food only (mainly due to the cost of buying wet food for 3 cats). She stays pretty well hydrated, as all her life she's kind of had an obsession with "new" water and loves her water fountain. (The amount of water she drinks is actually what made us bring her to the vet in March to make sure she didn't have kidney disease or diabetes.) She's also had a change in litter, and obviously in environment, and had some stressful events (the 12 hour drive to move, meeting new cats). I also know that we don't have enough litter boxes right now which may be upsetting her, as she's used to having boxes of her own. I am going later today to buy at least 2 more boxes and figure out where to put them. If it's possible going back on wet food would help her too, I'll start buying it for her again.

The vet said that if the problem persists, they will want to take x-ray images to rule out bladder stones. My issue though is that I don't think that I could afford it; I've already been struggling with the vet bills since March (the initial appointment was very expensive, plus mutiple follow-ups), especially after spending everything I had treating her brother last year. He needed imaging done too at the end and so I know how expensive it can be. I started a wellness plan at Banfield, so at least the cost of her office visits are covered now. She has an appointment already booked this week to retest her T4 and refill her prescription, so of course I'll bring this all up to her vet, but I'd appreciate any advice.

And here's the cat tax.
 

FeebysOwner

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Hi! Often times, getting thyroid under control will reveal kidney disease, so thorough blood work, including a chemistry panel will shed light on that. If her previous tests did not show crystals, i am not sure why the vet wants an x-ray to look for them now. So, a question to ask them. If they didn't do a urine culture when finding bacteria in her urine, then they may not have given her the proper type of amitotic to eradicate her infection.

i do think the upheaval she has been through is likely attributing to her problems, and may in fact be a large part of the issue. But, given her age, I would rule out health issues first.
 
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elliebean

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She did have more bloodwork done at her last follow-up on April 19th, after a month of medication, when her T4 was down to the low end of normal range (it went from 7 to 0.9 µg/dL, and her felimazole was adjusted). There was still no indication of kidney issues, would they take more time to appear? And yeah afaik no urine culture was done, and I don't think I could get one done right now as I'll have to pay the repeat urinalysis & T4 tests out of pocket since it's not included in her wellness plan.
 
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elliebean

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I can't seem to edit posts but I went and looked at her lab records from April 19th (where they said everything looked okay) and her creatinine is in their "normal" range but is at 2.1 mg/dL, her BUN was at 28 mg/dL. She's a small cat too if it matters, she's only 6 lbs.
 

FeebysOwner

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Actually, according to IRIS guidelines a creatinine level between 1.6 and 2.8 is considered Stage 2 of CKD (chronic kidney disease), so it would seem she does have CKD. Did the vet mention anything about it? I don't think the size of a cat matters. What was her phosphorus level? At Stage 2, it should be under 4.5.

At Stage 2, most cats don't really show outward signs of CKD, but it is a good time to start learning about it and have a discussion with the vet about their opinion/assessment. There are other factors that play a role in CKD and its progression. The vet should be aware of the things that need to be monitored and treated when needeI highly encourage you to start reading through Tanya's web site - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org). It is very comprehensive and scares some people off, but it really is worth taking the time to learn more about CKD.

Editing posts is allowed once you have reached 20 posts, so you should see an 'Edit' option on the lower left hand side of your post I believe editing is permitted for 120 minutes once you have created a post. More is covered about here - Promotions and Benefits | TheCatSite.
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elliebean

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No, they never mentioned anything about it. Her phosphorous level that day was 5 mg/dL, so I assume I'll need to change her diet (our cats are on Nulo kibble at the moment). I'll definitely bring it up at her appointment Friday. Thank you for the link.
 

mrsgreenjeens

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The change in litter could also be a reason she is not using the box. Cats do not like change, and she's having a lot of changes thrown at her all at once. When you get the new boxes, try adding some of her old litter to one of them and see if that helps.
 

silent meowlook

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Hi. Creatnine of 2.1 is significant for early kidney issues. The thyroid can mask that. But being as it is regulated now. That is good.

if there is any way you can do it, get the X-rays done. The behavior you describe is very much in line with bladder stones. Maybe she doesn’t have them, but if she does, you need to know, so you can treat accordingly.

Do you know what the urine pH was?
 
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elliebean

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Her urine pH was 6.5 (listed as normal). Is there a way to attach pdfs here? I could just upload all of her labwork if so.

Also, last night at some point she came and sat on my lap, and accidentally peed a few drops while sitting. It's the first I've noticed any incontinence and I'm not sure if that's why she would go back and forth to the boxes sometimes. She hasn't been doing it today though that I've seen, and she's using the new litter pans we got yesterday. In any case I'll bring it all up to the vet for sure, and I'll tell them our budget and ask what we should prioritize this week. I'm not opposed to spending all my money on pet care, it's been lots of ramen or rice type meals in our house the last several weeks making sure she's cared for, we just unfortunately can't do everything right now. Thanks again for the help
 

FeebysOwner

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If you have the lab work in a pdf file, you can use the "Attach Files' link in the bottom left hand corner of your post to share them here.
 
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elliebean

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Sorry for the late response. Attaching files only seems to allow image formats, but it's alright. When I took Callie (I don't think I mentioned that's her name!) to her follow-up appointment, her vet wasn't there for some reason, and no vets were in the office, so she didn't have a urinalysis then and I didn't get to talk to anyone until a vet called me later. I talked with her vet on the phone about possible CKD, and she said she'll do an SDMA test at her next thyroid follow-up.

Callie ended up not having any more urinary issues for a while, but I took her back in this week as she had some episodes of incontinence until she passed some bloody mucus (looked the same as when her brother had a UTI last year). Her vet didn't do another urinalysis; she said it did seem like my girl had another UTI, so she went ahead and prescribed another course of clavamox, but when they did a physical exam they could feel a large stone in her bladder, and an ultrasound showed stones. I couldn't afford any imaging today to confirm what kind of stones they may be, but I will get some x-rays for her as soon as I can (in a few weeks). I was prescribed some food for her (Hills c/d) to see if she'll improve until then, as well as some gabapentin. Vet did say if they are the kind of stones that can't be dissolved, Callie is so old that surgery would probably be too risky. I really hope the worst doesn't happen... I don't think I could take it so soon after losing her brother. :( Anyway, the gabapentin so far leaves her pretty wobbly/uncoordinated for a couple hours, which I feel bad about, but I don't want her to be in pain either. Luckily she's never been picky about food and is gobbling up the prescription food just fine so far. I'll update again whenever there's news.

Edit: Oh! And I realized my link was broken in my first post, so here's the cat tax for real.
 

mrsgreenjeens

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Oh! She is absolutely beautiful :loveeyes:.

Fingers crossed the Hills C/D does the trick.
 

silent meowlook

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Hi. I would suggest you try to find another vet. Preferably a cat only vet if you can.
If it is struvite stones, they can be dissolved with diet. Some other types of stones cannot. But, if she has a stone so large that the vet could feel it, I would think that trying to dissolve it with diet ( if it is the kind of stone that can be dissolved) would be a long painful process if it even worked at all.

Seventeen is not too old to have bladder stones removed. But, I would never do the surgery with a vet that said what yours did.

Financially, that is a different story. What area are you in? I know, where I am in Southern California there is the FACE foundation that will pay for surgeries in cases of financial hardship. There might be something similar in your area.

There is also links on this site as to what to do if you can’t afford vet care.
If there is a stone that large, it has to hurt.
 
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elliebean

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But, I would never do the surgery with a vet that said what yours did.
Sorry, that's a worrying statement, could you elaborate? And the vet agreed she likely has pain, that's why she was prescribed the gabapentin. I didn't question the vet why surgery would be risky because I know 17 is pretty old.

We're in the Colorado Springs area. I just moved here and have been taking her to Banfield/Petsmart as their wellness plan has saved us money on her care (they wave the cost of the office visits, which so far have been twice a month). Though if she ends up having surgery I would call around different places to see how much it would cost.
 

silent meowlook

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The reason I said that is because you don’t want a veterinarian doing a surgery they are not comfortable doing.
 

fionasmom

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Another reason for looking into a specialty group of some kind if you were to consider surgery is that they are set up for all eventualities and have doctors who are very competent with higher risk patients, use of anesthesia, recovery, round the clock nursing care.
 
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