UTI in Elderly Cat with CKD

epona

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I know all the advice and have re-read the Feline Lower Urinary Tract Disease (FLUTD) | International Cat Care link.

Just really want to ask for good vibes for my darling Jakey.

He's 17 years old, never had any bladder issues before but has CKD and has been on Fortekor for 18 months or so.
This week he has developed a bladder issue, he's been doing little wees all over the place so we took him to the vet and the vet detected blood in his urine.

He's not blocked and I know to keep an eye on him and rush him in as an emergency if that happens.

He is on gabapentin for the pain/stress (although we couldn't think of a stressor right away, there was a dog barking in the flat next door last week) but had to after veterinary advice halve the dose because the first dose affected him severely and didn't get cleared out of his system quickly due to his kidney issues. He'll be back at the vet on Saturday if there's no improvement by then.

Please wish him luck and good bladder recovery vibes - he is loved and cared for well by us and has good veterinary care, but it is very worrying given his age and his health conditions and we want him to get better and have a bit longer with us.
 

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You might ask your vet about using soothing herbs such as red raspberry, marshmallow root or chamomile to help relieve Jakey's discomfort. Those herbs are also used in humans (myself included)and if you look at the ingredients lists of feline-specific preparations, you will often see them. A sometimes overlooked rule is to separate marshmallow root (as well as slippery elm, if you ever have occasion to use it) from modern medications by 4-6 hours because the soothing mucilage of those herbs can coat the alimentary tract and inhibit absorption of meds.
 
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epona

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Thanks everyone!

Tests showed it was a bacterial infection, so he's on antibiotics now, hopefully that will sort him out.

It's all a bit of a worry (both the illness and the medications) due to the CKD, hopefully he comes out the other side in one piece and with all his organs still functioning.

Love my darling boy!
 
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epona

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He is currently just weeing wherever - he just went on my lap, didn't squat or anything, wee just came out of him while he was sitting here.

I keep trying to remind myself he's only been on antibiotics since Saturday, but I'm terrified he might have permanent bladder damage or something because he is just weeing everywhere.

My main concern is for his welfare, it's horrible to have everything soaked in cat wee but I just need some reassurance that he can recover from this without permanent bladder damage. I think I might see if I can speak to the vet by phone tomorrow.

I do what I have to do to care for him and I love him so so much, but that doesn't mean I am not stressed - I've been sleeping scrunched up on a 2 seat sofa with him for 2 weeks because he has ataxia from the gabapentin, he's on 5 doses of an assortment of medications a day so I'm up at all hours with alarms going off giving him pills (thank goodness for pill putty, which he loves), I literally have no clean clothes now because he has weed on absolutely everything.

I will do absolutely everything in my power to get my darling boy back to some semblance of health, but I am so so tired and stressed - not showing it to him ofc, it's amazing what you can cope with stoically when you have to - but I'm exhausted.

My husband can't really help because Jakey has always (since before we got him) been a bit wary of men, he hasn't hissed at my husband for over a decade but his interaction is limited to wandering over and giving his hand or foot a quick sniff or lick, so I am his sole carer while he is unwell.

Please keep my lovely sweet boy in your thoughts - he is such a darling and I love him and want him to recover for a bit longer with us.
 

silent meowlook

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If you feel like listing the meds he is on it might be helpful. If you just want well wishes, I totally understand that. You have them from me.
If he isn’t under the care of a specialist, it would be in his favor to be so. There are drugs that may help with the smooth muscle of the bladder to improve the outcome.
I am sorry you both are going through this.
 
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epona

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If you feel like listing the meds he is on it might be helpful. If you just want well wishes, I totally understand that. You have them from me.
If he isn’t under the care of a specialist, it would be in his favor to be so. There are drugs that may help with the smooth muscle of the bladder to improve the outcome.
I am sorry you both are going through this.
He is on Synulox (a branded antibiotic blend of amoxicillin and clavulanic acid), 50mg twice a day at 6am and 6pm.
Gabapentin for pain relief, 25mg (a low dose, he started out on 50mg but due to CKD wasn't clearing it out of his system within 12 hours so the dose was halved) twice a day at noon and midnight. This is the medication that causes ataxia, I am hoping that the weeing on my lap is just because the medication makes it difficult for him to move off me in time, rather than the weeing on me being due to bladder damage. When we take him off this, I want to taper him off it, I'm aware of humans who have terrible withdrawals when they stop taking gabapentin, but that isn't always accepted in veterinary medicine and I've heard of people being told to take their pets off it cold turkey - I am keeping a few pills back (I was given more than I need I think) to halve his dose down for a week when he comes off it - if humans get terrible withdrawals, animals are likely to as well, they just can't tell you that they feel awful.
Fortekor - brand name for the veterinary medicine version of benazepril hydrochloride, an ACE inhibitor to lower blood pressure and help with kidney function - this is his long term medication that he's been on for 18 months for the CKD - he takes 2.5mg daily at 10pm.
I'm in the UK if that helps with working out various brand names for medications.
 
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FeebysOwner

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I don't know what makes you think Jakey has bladder damage, but at least talk to the vet about this and see what they say, so you can stop worrying about it if there is no reasons to be concerned. Generally speaking, CKD damages the kidneys, not the bladder, Some times it can take a while for antibiotics to knock out an infection, other times if it isn't the most appropriate type of antibiotic it may not entirely eradicate it. Was there a urine culture done to see what would be the best type of antibiotic for his infection? I think because CKD cats can be more prone to infections that additional water intake may be necessary to help keep his bladder flushed, sometimes in the form of sub-q fluids, which can be administered at home. My 19+yo cat who has CKD gets daily sub-q fluids.

I don't know if Jakey has other issues with his bladder, such as crystals or blood, but if the main issue is primarily bacteria, you might consider giving him pure D-Mannose which helps clear out many forms of bacteria in the bladder. It also appears to offer overall health benefits to the bladder. I give my cat pure D-Mannose and that has pretty much stopper her bladder infections.

Lastly, some cats benefit from anti-spasmodic meds when there is an active infection. It might be part of the reason he pees as he is currently doing. So, bring that up to the vet too. It might help more than the gabapentin if he is experiencing bladder spasms.
 
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epona

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I don't know what makes you think Jakey has bladder damage, but at least talk to the vet about this and see what they say, so you can stop worrying about it if there is no reasons to be concerned. Generally speaking, CKD damages the kidneys, not the bladder, Some times it can take a while for antibiotics to knock out an infection, other times if it isn't the most appropriate type of antibiotic it may not entirely eradicate it. Was there a urine culture done to see what would be the best type of antibiotic for his infection? I think because CKD cats can be more prone to infections that additional water intake may be necessary to help keep his bladder flushed, sometimes in the form of sub-q fluids, which can be administered at home. My 19+yo cat who has CKD gets daily sub-q fluids.

I don't know if Jakey has other issues with his bladder, such as crystals or blood, but if the main issue is primarily bacteria, you might consider giving him pure D-Mannose which helps clear out many forms of bacteria in the bladder. It also appears to offer overall health benefits to the bladder. I give my cat pure D-Mannose and that has pretty much stopper her bladder infections.

Lastly, some cats benefit from anti-spasmodic meds when there is an active infection. It might be part of the reason he pees as he is currently doing. So, bring that up to the vet too. It might help more than the gabapentin if he is experiencing bladder spasms.
Thanks, it's just me thinking aloud really - need somewhere to talk about it.
I'm currently in a situation where everything is covered in wee and it's a bit stressful - he's just weed on my lap again a few minutes ago, I've been sleeping on the sofa with him to help him due to the ataxia and this morning I woke up with my tshirt soaked in urine and him peeing on my pillow right next to my face and it's just all a bit depressing.

Cultures were done and he is on the right antibiotic for the bacterial infection - but there were 2 failed attempts at the vet to get a urine sample from him and I eventually managed to get one myself at home - so it delayed the start of antibiotic treatment by something like 10 days (honestly it was ridiculous the way they messed up getting a sample, I took him in with a full bladder and while they were messing about working out where to put the needle in for a sample he weed down the vets' leg, if they'd had someone hold a bowl under his rear end they'd have had a sample several days earlier)

It's just me feeling very down about the whole thing and worrying that we won't ever get back to a "normal" state.
I love him so much.
 
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epona

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The reason I was concerned about bladder damage due to the infection going untreated at first is because generally most healthy cats will not wee where they are sitting and then continue to sit in a puddle of wee - if it's just a case of going in the wrong place, they still tend to squat and then move away from the urine when they have finished - not just do it where they are and continue to sit there with their hind quarters wet.
 

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I hear you and can totally relate. I have had to get urine samples for my cat for many of the last urinalyses. The vet kept telling me that her bladder was empty. So, when they wanted a urinalysis in January, I caught a sample, took it in, the urinalysis showed bacteria, but then the lab claimed there wasn't enough urine for the culture. By that time, she had started peeing outside the litter box - which she never did before back when she was getting frequent infections. So, it took me until March to catch more urine for the culture, and she was put on antibiotics for 14 days. They retested her urine, thankfully via cystocentesis, in April and she is bacteria free.

She is still peeing outside the litter box, and no one knows why. BUT it is not the same as with Jakey. She is not leaking urine, she just doesn't want to use the box, will verbalize that she needs something, and then wander the house looking for other places to go. So, we take our cues from her verbalization and put her in the box and keep her in there until she pees.

I understand your concern about the manner in which he is peeing, but I am not familiar with a bladder infection causing nerve damage to the sphincter muscles which is usually the reason behind incontinence. I still have to wonder if Jakey's leaking issue is related to FLUTD, and spasms can be part of that, especially with a UTI. That is not to say that the antibiotics won't clear up the spams, but as I said it can't hurt to ask the vet about both the spasms and the incontinence.

There is one thing you could consider doing while you are trying to resolve his issue permanently - get belly bands to catch the pee. They are specifically for male pets, mostly dogs, but some of the smallest ones will work on cats. They don't impede pooping 'normally'. Just one example - Amazon.com : Teamoy 4pcs Reusable Wrap Diapers for Male Dogs, Washable Puppy Belly Band (XS, Black+ Gray+ Green+ Purple) : Pet Supplies
 
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epona

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I've done a bit of reading and it seems that Gabapentin can (not always, but as a an uncommon side effect) cause urinary incontinence due to relaxation of the urinary sphincter - in both humans and cats, usually starting after a few days use and usually resolving after discontinuing the drug.
This gives me hope that after I taper him off it (I think next week, I need to speak to the vet about it on Tuesday) he may regain some bladder control.
Poor love is just weeing in his sleep at the moment and waking up in a puddle of his own urine which is not a good quality of life if it was likely to be permanent - I have got some puppy pads to put on my lap and on his favourite spot on the sofa, but of course they still get damp while he's on them, and as an elderly cat who is currently unwell and drugged up he's asleep about 90% of the time.
This is incredibly stressful but I have some hope, and we'll see how he does over the next couple of weeks once he's off the Gabapentin. He still has at least another week of antibiotics to go.
 

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I guess if it were me, I'd ask the vet about discontinuing the gabapentin and if need be give him something else instead. I would not want to be putting my cat through that if it is the gabapentin. Did you look into the belly bands?
 
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epona

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I guess if it were me, I'd ask the vet about discontinuing the gabapentin and if need be give him something else instead. I would not want to be putting my cat through that if it is the gabapentin. Did you look into the belly bands?
I will ask the vet on Tuesday when they are open, I want to taper him off now and see how is does when he's off it.

Belly bands/nappies will be absolutely last resort for him, he doesn't accept anything on or around him (harness, body suit after surgery etc.) I just don't think he will accept either having it put on, or wearing it. I mean if he doesn't regain some bladder control after he's off the gabapentin then I will consider it, but from experience of him I don't think it will be something he will adapt to. You know what cats can be like.
 
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epona

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Phoned the vet surgery - our regular vet is away for the next 3 weeks, but the locum wants to see Jakey tomorrow.
Please wish us luck.
He's still eating well, grooming himself (well as much as he ever did, he's never had a high standard of grooming, usually just his face!) and still kissing me on the nose and putting his arms round my neck for a cuddle, but he's clearly in a state and wet with urine and sleeping a lot.
I don't want it to end like this for him in a puddle of his own pee and confused on drugs for the last stretch, please please send vibes that he is going to get better and have a bit longer with us happy and well.
 
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epona

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Feeling rather more positive after the vet visit, and the sun's out today so he's perked up a bit, he's currently on his sunbed by the window enjoying the warmth and light :)

Vet suggested a 3 day taper before stopping the gabapentin as he's only on a low dose that should be sufficient, so I'm halving his daily dose as of today and stopping on Saturday.
He has antibiotics until Sunday, on Monday I am to take a urine sample to the vet to be tested to see whether the bacteria is gone or whether he needs a 2nd course of antibiotics - I'm aware that bacterial UTIs can need more than 1 course/type of antibiotic to fully clear them, so was not too surprised that they want to do another urinalysis on Monday

(is it OK if I do a little grumble about the mounting vet bills at this point? I love my boy but it's a bit ouchy on the wallet! Not that he's not worth it, but I suspect someone high up in the vet company is driving around in a very nice car, their markups on medication/food etc are shocking - I order meds online usually but not always possible when you can't wait for delivery...)

So we'll see how he is next week. He seems quite cheerful today. Oh and he's put on weight this week which is great as he is a bit underweight, it can be so difficult with elderly cats to get them to put weight on, especially when they are on a restricted diet.

The stand in vet fell in love with him, everyone does - apparently she's heard from other vets in the company that have treated him all about what a sweet and gentle cat he is - he's a softy.
 

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Good for him, bad for you wallet - I know! I am surprised that they want to test his urine so quickly after completing the antibiotics. I have always heard that it is best to wait about a week to ensure the antibiotics are not influencing the results.
 
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epona

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Good for him, bad for you wallet - I know! I am surprised that they want to test his urine so quickly after completing the antibiotics. I have always heard that it is best to wait about a week to ensure the antibiotics are not influencing the results.
Thanks, I'll phone the vet before the end of the week to double check that, sometimes there's a lot of information to take in during a consultation, and it never hurts to double check!

Just been having an awful week, our washing machine caught fire during a spin cycle on Monday and we had to call the fire brigade - so we're now in a situation with an unwell cat widdling all over and no means to do laundry at home - worst possibly time to be without a washing machine 😭
 
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