Older female cat with blood clots in urine

[profcat]

My darling Maggie (the cat in my profile photo) just turned 17. She's been holding steady with CKD for 2 years. She gets fluids every night and her kidney values have largely stayed the same. She is on prednisolone every other day (low dose) for her allergies-- she's always stuffed up and congested. That's been going on for 3+ years but she's been on the preds for about 6 months. She's also on Orbax for the upper respiratory infections she gets from her allergies. So she's been on that for a month.

Over the past few years, she has occasionally had UTI-like symptoms. She cries in the box (sometimes the bathtub), pees out a little blood and sometimes a clot, and then urinates normally again. This happened this past April and cleared up right away. It happened again 2 days ago (Saturday morning). She cried and jumped in and out of the box a bit. She urinated a normal amount but also urinated out two small clots. Yesterday she was fine. She's eating and acting great otherwise. She does have a difficult time cleaning herself, though. I brought in a urine sample this morning to the vet and the vet surprised me by saying she must have a bladder tumor. There is no way she could have an infection while on the antibiotic, and a tumor is most likely. The only way to confirm would be an x-ray at a specialist with contrast. And we wouldn't put an older cat through surgery. So at some point, she would just not be able to urinate.

This is horrible. I don't want to wait until I have to decide if she can't urinate and then we put her down in an emergency situation. That would be terrible. I guess we could get the x-ray and then we'd know for sure, but I hate even putting her under for that at her age. I love this vet and have used him for 10+ years but sometimes he goes to the worst-case scenario first (which can be helpful sometimes!). I think there has to be a possibility of a UTI or even just irritation in her bladder that would cause an occasional clot but wouldn't mean a tumor. Has anyone else experienced this before?

 

[FeebysOwner]

I think you should follow through with the x-ray (or an ultrasound), just so you have a better idea what you are dealing with. Whatever the outcome, it might also help the vet to suggest other treatments besides surgery. And it is not necessarily so about the infection not being present while being on antibiotics, especially if it isn't the correct antibiotic for her type of infection.

I would also ask the vet why your cat needs sedation for an x-ray - most of the time it is not necessary. At a minimum, it could be a small dose of meds just to relax her and not full-on sedation. An ultrasound usually also does not require sedation. My 18+yo cat has never had sedation for any x-rays, and she also has been through 3 ultrasounds, whereby she only once required a very small dose of butorphanol, and that was to reduce her squiggling when they shaved her belly the first time.

 

[Kris107]

Sorry to hear about what's going on with Maggie. One of my babies got a bladder tumor. We didn't even know until one day he peed out some giant clots onto our floor. It was horrifying and scary. We took him to the ER and they put in a catheter to relieve him and we brought him home to see how he held up. But he got blocked again (overnight) and couldn't urinate. He was very distressed. They did an ultrasound and saw the tumor (the cause of the bleeding). They said the kind of bladder tumor and location did not give a very good prognosis. Cancer is a horrible beast.

 

[fionasmom]

I realize that you may have already ruled this out, but I wondered about bladder stones. It would require imaging but I agree that sedation may not be necessary. Fiona herself had bladder stones removed when she was late middle age.

 

[silent meowlook]

Hi. It never hurts to get a new set of eyes on a complicated cat case. Look for either a feline only hospital or a specialist in either urology or internal medicine. There are drugs that can help bladder cancer. I would highly suspect bladder stones as well.

 

[profcat]

Sorry to hear about what's going on with Maggie. One of my babies got a bladder tumor. We didn't even know until one day he peed out some giant clots onto our floor. It was horrifying and scary. We took him to the ER and they put in a catheter to relieve him and we brought him home to see how he held up. But he got blocked again (overnight) and couldn't urinate. He was very distressed. They did an ultrasound and saw the tumor (the cause of the bleeding). They said the kind of bladder tumor and location did not give a very good prognosis. Cancer is a horrible beast.

Oh, how horrible! We have had 2 male cats block over the years, but both times it was from mucus plugs and not anything as serious as a bladder tumor. Cancer is so terrible. I'm so sorry for your furbaby.

 

[profcat]

Hi. It never hurts to get a new set of eyes on a complicated cat case. Look for either a feline only hospital or a specialist in either urology or internal medicine. There are drugs that can help bladder cancer. I would highly suspect bladder stones as well.

Yes it could be bladder stones or even kidney stones. I also read that just cystitis can cause bleeding and clots. We will wait for the urinalysis results tomorrow and see what those say.

 

[profcat]

I realize that you may have already ruled this out, but I wondered about bladder stones. It would require imaging but I agree that sedation may not be necessary. Fiona herself had bladder stones removed when she was late middle age.

We just had a cat with bladder stones and it was such a brutal surgery for her to recover from-- and she is only 8. I'd hate to put my Maggie through that but maybe it's an option if that what it is.

 

[silent meowlook]

I completely understand you not wanting to take a 17 year old CKD cat to surgery. I do get it.

 

[profcat]

An update: We took her back to the vet when she was straining on Thursday for an x-ray. They didn't need to put her under for that (but will have to for an ultrasound). They didn't see anything on the x-ray other than her old spinal injury is worse from age (she was injured as a kitten before we got her). The vet thought she could be resistant to Orbax so we should try doxycycline which she has never been on before. She's doing great on it! No straining at all over the weekend and her appetite is great. She's acting much more like herself again!

This could just be another UTI like she's been getting every once in a while for a few years. The vet did see white and red blood cells in her urine. It could also be stones or a tumor causing those UTIs. So we have a choice-- we could do an ultrasound on Thursday and see what is going on. I hate putting her under and stressing her out, though. Especially given that she's doing better. I tend to go with the simplest explanation (she's 17 and has a history of UTIs) and my vet tends to go with the worst-case scenario (a tumor-- and I'm not sure we'd put her through surgery). I do appreciate him thinking of the worst case because that has helped us before with our cats and he's very thorough. The ultrasound can be done any time, so maybe we should wait and see if she gets another UTI and then do it?

 

[FeebysOwner]

I may have already mentioned it - if not on this thread, certainly on many other threads. Find out why your cat needs to be sedated for an ultrasound - and if that would really mean 'putting her under' as you describe it. It is often unnecessary. My cat has had 3 ultrasounds, and only once was she given a small amount of butorphanol to calm her for the belly shave. This drug does not even cause a cat to sleep, it is fast acting, and wears off pretty quickly.

 

[profcat]

I may have already mentioned it - if not on this thread, certainly on many other threads. Find out why your cat needs to be sedated for an ultrasound - and if that would really mean 'putting her under' as you describe it. It is often unnecessary. My cat has had 3 ultrasounds, and only once was she given a small amount of butorphanol to calm her for the belly shave. This drug does not even cause a cat to sleep, it is fast acting, and wears off pretty quickly.

I think it's because of her spinal injury that she is very hard to hold steady for even the x-ray. She's very strong and wiggly. I will ask the vet again, though. Maybe just giving her something to calm her would be a better idea. I'll ask. Thanks!

 

[profcat]

I forgot to add that her bloodwork was all good. Her kidney levels are a little higher, but not unexpected at her age.

 

[silent meowlook]

Hi. I have to say, if it was me, and everything is going well, I doubt I would stress her with additional diagnostics either. You have to think about what changes will you make depending on the results of the diagnostics. If there is a tumor, what will you do different? If you won’t take her to surgery, maybe there is no need to know. Provided of course she is doing well. The second that changes, maybe then do additional diagnostics.

With the doxycycline, is it a liquid or pill. It is important to rinse her mouth and have her drink or eat something after the doxycycline. I’m sure they told you that.

You might want to ask your vet about having you do some SQ fluids at home. They are easy to do and the fluids will help keep the urine dilute and prevent bacteria from building up, or blood, or anything else due to the dilution of the urine. Ot will also help with the kidneys.

Just a thought.

Glad she is doing better.

 

[profcat]

Hi. I have to say, if it was me, and everything is going well, I doubt I would stress her with additional diagnostics either. You have to think about what changes will you make depending on the results of the diagnostics. If there is a tumor, what will you do different? If you won’t take her to surgery, maybe there is no need to know. Provided of course she is doing well. The second that changes, maybe then do additional diagnostics.

With the doxycycline, is it a liquid or pill. It is important to rinse her mouth and have her drink or eat something after the doxycycline. I’m sure they told you that.

You might want to ask your vet about having you do some SQ fluids at home. They are easy to do and the fluids will help keep the urine dilute and prevent bacteria from building up, or blood, or anything else due to the dilution of the urine. Ot will also help with the kidneys.

Just a thought.

Glad she is doing better.

We are doing SQ fluids at home daily and it's kept her kidney values low for the last two years (since she was diagnosed with CKD). The doxy is a pill and she is HORRIBLE at taking it. I hate stressing her out. We do give it to her like 30 minutes after breakfast and dinner, so she has some food in her stomach first. It has not made her get sick at all. I'm not sure we can get her something to eat after thought, as she's pretty unhappy with us after she gets it! THANKS so much!

 

[silent meowlook]

When you give it, try wrapping it in a pill wrap or something, and pull her that way. The fear with Doxycycline is that it can cause esophageal structures if it contacts the esophagus. So you want to wrap or coat it with something before giving. Rinsing after isn’t a good idea if she gets stressed because then you risk causing aspiration pneumonia.