What to do?

[lilliannah]

I am rather flummoxed by a set of seemingly disparate illnesses of my cat. He just turned five and was perfectly healthy until last December.  His urethra blocked three times in a single week with no history of urinary issues.  At the end of the week it was a choice to put him through pu surgery (which is pretty major surgery where they alter the male urethra to resemble the shorter, more open female urethra) or to let him go...letting go was not an option so $3K later he was starved but home and on the mend.  

It is now seven months later and he has the same symptoms...cannot seem to urinate, excessive licking...but the chances of him reblocking are crazy rare so I think maybe its just a uti...they often get chronic uti's after pu surgery...so back to the vet where they sedate and get a urine sample...they say its a uti and send him home with antibiotics...he gets better within days and all seems well until they call to tell me the urine culture is back and he has a highly resistant strain of staph infection in his bladder...

After researching I have realized it is highly, highly rare for this strain to be in the bladder and to top it off they say he appears to have signs of liver and kidney failure...clearly my hope for a simple uti was for naught...they changed his antibiotic and now he is not urinating and has massive diarrhea plus is barely eating so I have stopped the antibiotics.  The vets have yelled at me and told me I'm basically killing him because this bacterial staph is highly aggressive but I can't rationalize leaving him on meds when they are making him sicker.  If he has kidney damage (as they are saying) won't a lack or urination make this worse? 

I keep trying to rationalize a perfectly healthy cat blocking three times in a week resulting in surgery and then months later getting a super rare type of infection and oh, by the way, there is kidney failure that was previously fine (I  say this based on his lab results from the time of the surgery 7 months prior).
I know much of this is fear ...terror really...I was so near losing him months ago and to watch him fight back and be finally okay only to have this new challenge seems so unfair to him...

Has anyone experienced or heard of anything like this...to this degree?
I've found cases of pu surgery...and of chronic uti...and of kidney failure...but not all this severe and combined so I'm at a loss as to what to expect or how to help him...he has none of the symptoms of kidney failure except for the lab results and I'm clueless how he got this rare staph in his bladder...

Any ideas/help/advice/hugs would be greatly appreciated!

 

[tulosai]

I don't have any real answers for you but wanted you to know I am sorry you are going through this.  I would listen to your vet assuming that you trust them  and follow their advice and directions even if it seems counter intuitive and hard.  If you do not trust them, I would seek a second opinion.

Please keep us updated.  I am so sorry to hear about this and will be sending 

 to you.

 

[quiet]

Can you post the blood work and the urinalysis results here? What is the name of the antibiotic he is on? Have they tried to re do the culture to see if they somehow got a contaminate in the sample? Are you able to palpate his bladder? What did he obstruct with before? Was it crystals? What kind? A mucos plug? What is he eating? Does he drink any water? Are you using bottled water? Did you tell the vet the antibiotics are making him ill?

 

[zoneout]

What was he being fed?

 

[lilliannah]

The urine sample was taken with a needle straight into his bladder (cystocentesis)so would be rare for it to have gotten contaminated.  The antibiotic which made him sick (not eating, watery stools, etc) was clindymicin...after I stopped giving him the clin he started urinating normally again...

When he blocked back in Nov./Dec.  it was crystals(struvite)...three times in one week...the recent urinalysis results said there are no longer any crystals in his urine (yay!)...after the surgery he was switched to an all wet diet plus I add water to his wet food and occasionally add a bit of apple cider vinegar to his water to help keep him acidic...

He is quite good about drinking water on his own....he has a fountain using distilled water...

Urinalysis results...

Bilirubin 2+(high)

Protein 2+(high)

Occult blood 3+(high)

RBC >50 (high)

Casts Hyaline - fine grain (high)

From the culture the bacteria was determined to be meth-resistant staph pseidintermedius (mrsi)

The prio vet did not like him because he is difficult for anyone but me to physically handle (hence their reasoning for leaving him in his carrier for so many hours) so I took him to a new vet today...both he and I like her quite well (perhaps I like her better than my cat does but he didn't have the urge to kill her and settled for a few hisses!)...she has put him on doxycycline so I am hopeful that will take care of the staph...after that she wants to recheck his other levels and maybe do blood work depending so I'm keeping my fingers crossed that the kidney/liver issues the last vet says he must have could be a fluke caused by the staph infection!

Thank you all for your thoughts! Its always so helpful to hear thoughts and experiences of others...I get too worried at times to think clearly!

 

[quiet]

Is the doxy a liquid or pills? Make sure to rinse with water after giving. Hopefully it is liquid as the pills can cause esophageal strictures. Some people just don't know how to handle cats. Glad you got another vet. The urinalysis, did they say what the specific gravity was? Very important. The red blood cells could be from the cystocentisis itself. Did they do an ultrasound guided stick? The red blood cells are odd being there without any white blood cells and make me think they got blood in their sample. Did they read it at the hospital? May also just be someone reading them that doesn't know what they are looking at.

Glad he saw another vet.

 

[lilliannah]

Unfortunately the doxy is in pill form...we called around all over but the nearest location with it in liquid form was an hour away....I've been lucky in that I can sneak it into a pill pocket and then after he chews it I'm still squirting water into his mouth...I think I need to just get a squirt gun instead of fighting with those little syringes hehe

Specific gravity was on the high side of normal at 1.046

I know they used the ultrasound to guide them but they didn't have an in house lab so the sample was sent off for the testing so perhaps something went amiss along the way...hopefully after a few weeks of antibiotics the staph in his bladder will be gone and the possible kidney/liver issue addressed!

 

[quiet]

Has his thyroid been checked? Have they mentioned you doing sub q fluids at home?

 

[lilliannah]

The new vet is holding off on more tests until the staph infection is cleared up so no thyroid checks yet...I'm not sure if he was dehydrated when this all started but as of Sunday he was not so no need for fluids at this time...fortunately he tends to drink a good amount of water (at least for a cat!)...

I know that once the infection is gone he will have to go through a ton of tests to rule some things out but for the moment he's doing quite well!