Bladder problems - blood in urine

AliceR

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Hello,

My cat, Sunshine has had chronic bladder issues since 2010. She is 16yrs old, SF, and hasn't had vx for the last 9 years.

She eats canned food, Weruva, petguard, halo, and a tiny bit of raw and chicken hearts.

I found blood around her cat box yesterday- throughout out the years she has been treated for this with Penicillin, CHCP, clindamycin, Jin Quai Stone, fluids, and probiotics. She has had an X-ray to check for stones. Some of her episodes showed struvite and oxalate crystals, some cultures showed nothing.

I gave her a little tinkle tonic (now out) and cranberry and d-mannose, also probiotics. I also started the flower essence UR fine and gave some aconite.

Her BEAM is good, however, she has regurgitated more frequently after pm meal in the last week. Then, she wants more. She also has kidney disease. Her last bloodwork in June showed Creatinine- 2.9, BUN- 57 and Phos 5.8. Her CBC was normal. She is on Calcitriol for the kidney disease.

I will bring a urine sample to the new vet on Monday.

Any thoughts would be appreciated.
Thank you,
Alice
 

Dr. Jeff

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Hey Alice-

Im sorry to hear about your Sunshine’s possible renal dis-ease diagnosis, but am so glad that her beam is good! 👍

Do you know if your vet is trending her calcium (calcitriol can cause hypercalcemiia), albumin, hematocrit along with her renal test results?

You may want to start adding extra water to her food and playing the hunt for special treats game every day to increase her healing.
 

AliceR

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Thank you, Dr. Jeff, for your response.

I am assume that my vet was trending her calcium etc. My vet unexpectedly retired in July. They didn't send me a copy of the tests and I was distracted by my cat, Sequoia, who ended up having carcinomatosis, so I didn't realize it until later. I only give the calcitriol 2x a week.

I do add extra water to her food and she has her own water bowl, she drinks quite a bit. I can try the hunt game, I play with her every morning with interactive toys and she likes that a lot.

Alice
 

Dr. Jeff

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You're welcome Alice, it's my pleasure and honor to be able to help. 🙏

I'm so glad to hear that you and Sunshine play every morning!

Adding a pm play session will definitely increase her emotional enrichment and thereby help her balance and any bladder or kidney symptoms.:catfood:
 

AliceR

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I took Sunshine to the vet and agreed to running a culture, which is happening now. Vet wanted to start on antibiotics but I said no, wait for results.
Also did blood work for kidneys - last blood work was in June. Creatinine and Phos elevated.
Creatinine June: 2.9
Creatinine Nov. 3.3

Phos June: 5.8
Phos Nov.: 7.7 (normal 6.3)

My vet wants me to feed food with lower Phos 300 or lower for mg/100kcal. I was wondering what it would be on a dry matter basis.

Also where does raw food fit in with Phos levels?
Sunshine has had 8 blood tests since 2016 and her Phos was as low as 5.1 and went to 7.3, 7.4, now 7.7 but before this it was 5.8.

My vet doesn't want me to use Phos bind, wants me to lower it with diet. But, doesn't that mean automatically a lower protein diet?

Sunshine has had no blood in urine today, BEAM still good!
Thank you,
Alice
 

Dr. Jeff

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I'm sorry to hear about Sunshine's kidneys, but great news about her hematuria (blood in urine) and BEAM.:)

She sure is lucky to have such a dedicated mom as you!:thumbsup:

Great questions about diet, phosphorus, etc.

Raw food can still be fed with elevated phos.

Darwin's even has a commercial raw "prescription" diet:


You may however need to mix it with a low phos food (like a high quality canned food).

This page has much for info on specific US brands:


Phos. binders can be very effective and important to use. However, they can be messy and difficult to administer.

If you can lower the phos with diet alone, great!

Phos. and protein go hand in hand, so it's tough to feed a meat-based diet low in phosphorus.

The USDA lists the exact phos. levels in most foods which might help you decide how/what to feed.

At 16 years young, the best is to focus on her quality of life and any food she likes to eat while you monitor her blood levels and focus on her happiness, play and interaction with you and her other favorite things.

Doing so will help her internal balance and kidneys!
 

AliceR

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Thank you, Dr. Jeff.
The culture came up with nothing, so vet thinks it is Idiopathic Cystitis. There is a chance it could be stones, but she has been x rayed for that in the past.

She has always been very sensitive.

She has had kidney disease since 2016 and values have not increased very much and have even gone down.

I really appreciate your thoughts on the Phos- I don't know how much I will push a raw diet as some foods cause her to regurgitate. However, once I feel she is over this episode, I will continue to give her bits here and there.
Sending her picture.

Thank you,
Alice

3A915B55-3769-4C80-A8FE-521863F0F9B1.jpeg
 

Dr. Jeff

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Hi Alice-

How about trying a batch of food for her that you make yourself?

It doesn't have to be raw, just fresh.

Blenderize white meat chicken with added ghee for extra fat and palatability (and lower phos than butter).

If she likes that, try adding in some wild blueberries or steamed chopped kale when you run the chicken through the blender.

Ninja blenders work well for doing this.
 

AliceR

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Thank you, I can try- she does eat slightly cooked chicken hearts once a week.

Alice
 

AliceR

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Dr. Jeff, in regards to making my own food, doesn't the recipe have to have organs as well as the chicken, and would I need to add a multivitamin and calcium?

Thank you,
Alice
 

Dr. Jeff

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Hi Alice.

Yes, organs are important and you may need to add a multi depending on how much variety you offer.

If you haven't already, take a look at the Holistic Essentials intro course that has lots more food tips.
 

Dr. Jeff

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🙏
 

AliceR

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Hello Dr. Jeff, Dr. Christina,

Sunshine came up with a new symptom this morning. Before breakfast, she vomited a little blood. About 2~ 1 cm size drops. She ate really well, her BEAM is good, she peed and the blood showed up again in her urine,

I was going to wait to call the vet, but after googling "blood in the urine" it was advised to see a vet as soon as possible.

She is still on canned food, though I did cook her a chicken breast, which she heartily ate, I just don't feel confident feeding it without a recipe. I did look at the intro course and that has helped, mainly with my dogs.

I do not have a separate freezer, so it is mainly filled with dog food.

Any thoughts in the blood in the vomit?

Thank you,
Alice
 

AliceR

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I called the vet and she suggested an ultrasound- your thoughts on that? Sunshine was a former feral kitten and worried about the stress. Put a call to Dr. Chris, homeopathic vet.
 

Dr. Jeff

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I agree about the effect of stress Alice.

Was the vomit primarily the blood?

If not, what else was in the vomit?

Her BEAM is good, but is it 100%?

A thorough physical exam by your local vet or Dr. Chris will help you determine if an ultrasound is indicated.

In the meantime, get her to purr more and play the hunt for treats game both of which will help her heal.
 

AliceR

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Thank you, Dr. Jeff.
She just had a thorough physical exam a month ago with bloodwork and the urine culture.
The vomit seemed like watery blood...maybe a little bile in it?
She is purring right now as I'm typing this- her appetite may be a tiny bit down, but it's hard to tell because it varies because of her kidney disease. I would say she is eating well, though.
 

Dr. Jeff

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You're welcome Alice.

Has Sunshine had any other vomiting/regurgitation, or persistent belly noises, burping, flatulence?
 

AliceR

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No persistent belly noises, burping or flatulence. She does regurgitate her food occasionally- the last time was on 12/2- I thought it was because I gave her bladder support (this was the 3rd day of it- as I noticed she had a little blood in her urine again), the time before was 11/9. She usually regurgitates immediately after eating. Then she usually wants more food. I wait a bit before giving her more and then smaller amounts at a time. I think part of why the vet wants an ultrasound is because there is still some blood in urine but not consistently, receptionist mentioned checking for stones- but wouldn't she have had crystals in her urine in Nov? Also, I asked about doing an X-ray but was told recommendation was ultrasound.

Thank you,
Alice and Sunshine
 

Dr. Jeff

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Great thoughts Alice! :thumbsup:

Yes the x-ray would be a much more affordable way to check for stones.

However certain stones don't show up on x-ray which is part of why your vet advises the ultrasound.

The ultrasound can find a lot more problems.

Especially if it is done by an internal medicine or radiology specialist.
 

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