Recurring Uti? Help!

[Miche11e]

Looking for advice. My cat Chester (3 years old) has been in and out of the vet 4 times in the past month. Long story short, they have told me he has struvite crystals. He has been catheterized 3 times, been prescribed Onsior 4 times and Prazosin 3 times. We tried switching to the Hills S/D diet and he refused and starved himself until we switched him to Hills C/D for stress (under the advisement of the vet). He eats mostly canned food with C/D kibbles left out to snack on, which he rarely does.
We have done everything to the letter. We have 3 litter boxes for 2 cats, bought a water fountain (that they refuse to use), keep the boxes clean, keep the water dishes and fountain clean. The problem is not with the other cat as they are twin brothers and have been together since birth.
Is my vet missing something? Should they be doing X-rays? I keep reading online about stones but they have not mentioned anything about it and just say he has struvite crystals. Why isn't this getting better? Should I change vets? (That is already on my mind as we brought him 30 hours ago to the vet and had an emergency consultation on the weekend because we knew he was getting sick again. We were given Onsior and sent home. This morning he was admitted with blockage and is being given his third catheter...)

 

[1CatOverTheLine]

.
M Miche11e - First, ruling our kidney stones should be near the top of your veterinarian's list. Idiopathic feline urinary tract disease can't even be effectively diagnosed until kidney stones have been ruled out, and the simple fact is that urinary tract infections in cats are - 99.5% of the time - bacterial, with the urethra as the entry point. Until the bacteria has been properly identified, and an antibiotic plus a bacteriostatic (Amoxicillin/Clavulanic acid as an example, where the Clavulanic acid acts as a bacteriostatic in concordance with Amoxicillin's bactericidal properties, preventing re-infection once the Amoxicillin has wiped out the initial infection), Chester might well continue re-infecting himself, as simple antibiotics may not be enough.

I'd ask how deep his litterbox is filled; "splashback" from an overfilled or undersized box will allow bacteria to re-enter the urethra, thus re-infecting the urinary tract.

Onsior is a non-steroidal anti-inflammatory pharmaceutical; Prazosin is typically prescribed for male cats already diagnosed with feline interstitial cystitis. You haven't noted your veterinarian's formal diagnosis, nor Chester's urine pH, nor the specifics on his symptoms, which makes it difficult to get an idea regarding his medical treatment thus far.
.

 

[Miche11e]

Thank you for the reply. All 3 litter boxes are quite large. I have never heard or read about over filling the litter so that will be something I will remain conscious of from now on.
The vet never truly gave us a firm diagnosis other than he had struvite crystals. There was mention of lower urinary tract disease but just in passing. He had a high PH (over 7) but the exact number I cannot remember right now.
Chester had all the normal symptoms. he hid it well the first time until he started urinaring around the house. We brought him in and they didn't do any testing and just said he was partially blocked and gave us Onsior and Prazosin. We thought everything was fine until two weeks later he went from fine to terrible in a day. No puddles, lethargic and puking. Back to the vet and this time he was cathetered. He spent 3 days and two catheters later we brought him home. This weekend he started licking a lot and gave us the "meow" that something wasn't right. We rushed him in and were given Onsior and sent home. This morning he went back to straining to pee, lots of pain, licking so we rushed him back where we were told he is fully blocked. He is at the vet now.
They just called to tell me is he awake and the catheter went in but not easily. I've asked for the vet to call me so I can ask the question about ruling out kidney stones. I've been searching throughout every website and blog available to also ask about bacteria and if they tested for it and re-evaluating the C/D diet. I've read that cats with struvite crystals should be on a grain free diet, yet the CD has wheat gluten in the canned food ingredients and whole grain corn in the kibbles. I'm wondering if a holistic natural grain free food or raw diet might be better with a urinary acidifier tablet instead of CD.. ?
I'm not sure what else I should be asking for. It's up to me to advocate for Chester and I'm trying my best to find what I can as it seems the vets aren't helping much.

 

[1CatOverTheLine]

I'm not sure what else I should be asking for. It's up to me to advocate for Chester and I'm trying my best to find what I can as it seems the vets aren't helping much.

I greatly dislike suggesting a consultation with a second veterinary surgeon, but if our places were reversed, I believe that I might seriously consider asking a second opinion. Remediating the bacterial infection - assuming that one is present - should be the foremost goal. Hopefully, some other members will chime in as the day wears on.
.

 

[Miche11e]

.
M Miche11e - First, ruling our kidney stones should be near the top of your veterinarian's list. Idiopathic feline urinary tract disease can't even be effectively diagnosed until kidney stones have been ruled out, and the simple fact is that urinary tract infections in cats are - 99.5% of the time - bacterial, with the urethra as the entry point. Until the bacteria has been properly identified, and an antibiotic plus a bacteriostatic (Amoxicillin/Clavulanic acid as an example, where the Clavulanic acid acts as a bacteriostatic in concordance with Amoxicillin's bactericidal properties, preventing re-infection once the Amoxicillin has wiped out the initial infection), Chester might well continue re-infecting himself, as simple antibiotics may not be enough.

I'd ask how deep his litterbox is filled; "splashback" from an overfilled or undersized box will allow bacteria to re-enter the urethra, thus re-infecting the urinary tract.

Onsior is a non-steroidal anti-inflammatory pharmaceutical; Prazosin is typically prescribed for male cats already diagnosed with feline interstitial cystitis. You haven't noted your veterinarian's formal diagnosis, nor Chester's urine pH, nor the specifics on his symptoms, which makes it difficult to get an idea regarding his medical treatment thus far.
.

Thank you for the reply. All 3 litter boxes are quite large. I have never heard or read about over filling the litter so that will be something I will remain conscious of from now on.
The vet never truly gave us a firm diagnosis other than he had struvite crystals. There was mention of lower urinary tract disease but just in passing. He had a high PH (over 7) but the exact number I cannot remember right now.
Chester had all the normal symptoms. he hid it well the first time until he started urinaring around the house. We brought him in and they didn't do any testing and just said he was partially blocked and gave us Onsior and Prazosin. We thought everything was fine until two weeks later he went from fine to terrible in a day. No puddles, lethargic and puking. Back to the vet and this time he was cathetered. He spent 3 days and two catheters later we brought him home. This weekend he started licking a lot and gave us the "meow" that something wasn't right. We rushed him in and were given Onsior and sent home. This morning he went back to straining to pee, lots of pain, licking so we rushed him back where we were told he is fully blocked. He is at the vet now.
They just called to tell me is he awake and the catheter went in but not easily. I've asked for the vet to call me so I can ask the question about ruling out kidney stones. I've been searching throughout every website and blog available to also ask about bacteria and if they tested for it and re-evaluating the C/D diet. I've read that cats with struvite crystals should be on a grain free diet, yet the CD has wheat gluten in the canned food ingredients and whole grain corn in the kibbles. I'm wondering if a holistic natural grain free food or raw diet might be better with a urinary acidifier tablet instead of CD.. ?
I'm not sure what else I should be asking for. It's up to me to advocate for Chester and I'm trying my best to find what I can as it seems the vets aren't helping much.

I greatly dislike suggesting a consultation with a second veterinary surgeon, but if our places were reversed, I believe that I might seriously consider asking a second opinion. Remediating the bacterial infection - assuming that one is present - should be the foremost goal. Hopefully, some other members will chime in as the day wears on.
.

The vet just called and we had a 40 minute conversation. His PH is still at 7 which is concerning because he's been on his special diet for over a month. Therefore she did a culture sensitivity test this morning but it takes 48 hours. She said there were lots of white blood cells which leads to believe there is an infection somewhere and could also be elevating his PH. I gave her the go ahead for a blood test to check kidney function and the whole list of things it also verifies. And I asked for him to get an ultrasound to check for stones. She seemed less on board than me about that and said kidney stones are very rare in cats and dogs (which I'm not sure about that fact) and said it's more probably in the bladder even though she did not feel anything in there. She still booked it anyways. They also have another specialty cat food they want us to try which I will but do not understand. The one he has now is designed for high PH but is possibly not working. She wants us to try one that is designed for both high and low PH crystals... Hopefully we will get some answers and if this does happen again, we will definitely be consulting another vet. Especially if it recurs in two weeks just like this time.

Yes hopefully others may have had similar experiences or heard of some that can give more advice of things I should be doing or questions I should be asking.

 

[babiesmom5]

While I have not had a male cat "block up", I have had one with struvite crystals and a female with both struvite and oxolate crystals. All wet food is essential...no dry. Also regulating the frequency of feeding is important. After a cat eats, its urine undergoes a temporary rise in PH. So multiple feedings or worse, free feeding, promote constant alkaline urine which predisposes to struvite crystals. Crystal prone kitties should be eating wet food twice a day.

Now as to what to feed, my cats tried different prescription foods; none of them great. But the one they most preferred, (especially if freshly opened), was Purina ProPlan UR. This is formulated for both struvite as well as oxolate crystals. This may be the one your Vet is referring to for both "high and low PH" crystals.

As I recall, the cats did drink a fair amount of water while on this food. An elevated water bowl helps and I kept it filled with ultra-purified Penta water (as we have well water with minerals).

If your cat blocks up again, you might consider consulting with a Vet specialist in Urology, most often found at Veterinary teaching hospitals. I know the Veterinary school in my state has a department of Urology with Vet specialists in this field.

 

[stephanietx]

You might also make sure that he's as stress-free as possible. Stress can contribute to UTIs. Do you run Feliway diffusers? That might help.

 

[Miche11e]

Chester is still at the vet and still we have no answers. His blood test came back fine. The sensitivity culture came back with no findings. The ultrasound revealed no stones and his kidneys looked good. The ultrasound revealed that he still has a lot of crystals and "sludge" in his bladder. They are going to attempt to flush it out with saline.
Chester is a nervous cat and always has been. I've never heard of the diffusers until just this week. Do they really work?
I don't know what to do. The vet said straight up that we need to start thinking of our "options" if this recurrs again. That isn't even a thought I can process, the only option to me is that he comes home and is healthy.
The only thing they seem to be able to tell me is that he has a very small penis which could be part of the problem. We've been told to think about the surgery but the vet said he was in the same situation with his cat and euthanized his cat instead. From what I've found on the surgery it doesn't look very promising.

 

[betsygee]

You might also make sure that he's as stress-free as possible. Stress can contribute to UTIs. Do you run Feliway diffusers? That might help.

My cat has not had problems to the extent yours has, but he also has had recurring UTIs and is a nervous cat. We started having a big problem with inappropriate urination everywhere in the house. He's on the C/D diet exclusively now and is also on Prozac. It sounds like your cat's medical issues are more serious than our Rico's are, but you might ask your vet what she thinks of calming medications.

 

[Miche11e]

How do you find it with your cat on Prozac? The vet briefly mentioned that having our cat "stoned all the time" could help if his problem is stemming from stress.
I personally don't think it is all stress. I feel like the blockage he suffered from 3 weeks ago didn't fully go away and that we are still dealing with the same issue. He vet told me that is probably not the case but I can't be so sure. But I'm also not a vet.

 

[betsygee]

Rico isn't 'stoned' at all. He is still our "Dennis the Menace" cat who loves to play and wrestle with our other cat and snuggle up to my spouse at night (he's a daddy's boy). But he used to run around at night to different rooms, meowing like he was stressed, looking for a place to pee. Now he just doesn't do that at all any more. It seems like he doesn't associate the litter box with pain now and uses it like he's supposed to.

Of course, as you mentioned, if your cat is still suffering from a blockage or something, that's a different ball game.

 

[MizLizzie]

We have recently been through this with our elderly gentleman. It is pure hell, I know. My heart goes out to you both. Our boy has IBD, so I monitor his litter boxes with video cams, and while I had noticed his urine stream was weak compared to his brother and littermate, I put it down to age, until suddenly it was a crisis.

My understanding of interstitial cystitis is that it usually hits young cats, and is chronic. Pelham is 15. This was his first bout. It has been just horrific. I thought we were going to lose him, or have to make a hard decision. Like your cat, we were just told he had "sludge." They didn't find actual crystals. He had signs of infection. They said his prednisolone for his IBD "may" have contributed. He is better now -- for now. But it took catheterization, several trips to the ER, cold laser therapy, accupunture, and prazocin. But what I think finally helped him was TWO MONTHS of orbax, subQ fluids every other day at home for three weeks, and finally, glucosamine-chondroitin injections. This is apparently a not well undertood therapy, but this is what turned the corner for Pel. You begin with two shots weekly for four weeks, then monthly for life, I think. Pelham just went on maintenance. We are on pins and needles, but so far he's doing well.

One of his ER vets -- the acupuncturist -- also practices Chinese medicine and our next step, if it returns, is to add an herbal treatment called "Eight Righteous" herbal blend to treat "damp heat in the bladder." Dunno. We have a tin of very expensive Eight Righteous the ER special orderd, but they sell another blend on Amazon quite inexpensively which seems to contain the same things, and based on reviews, it has helped many cats with cystitis. You might ask your vet if it would be okay to try. Also, I know three folks whose cats have had the streamline surgery, and all went well. This isn't to say it is not a dangerous surgery, and once a lot of scarring has occurred, chances of success go down, I am told.

Hang in there.