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Cat UTI and kidney problems -peeing outside box

BarbaraPB

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Good Morning,

Misty is a 13 year old rescue and was diagnosed with kidney disease in October 2022 when she had an acute issue ( possibly UTI) where her kidney values increased. She had another UTI in March 2022. Currently she is on petsiac, aminivast, l-lysine and B12. As of March she was doing well and her kidney values were improved.

The reason I’m writing is because I brought her to the vet yesterday for an emergency appointment ( didn’t see my regular vet ) because she was in and out of the litter box and peed outside the box. I watched as she sadly squatted in my dining room. There was also mucusy blood when I cleaned up the urine.

The vet’s thoughts are that her bladder is spasming, couldn’t hold urine and treated her with a steroid and anti-inflammatory and gave her 150 ml of fluids hoping it would help to flush her. They couldn’t get a urine sample ( misty peed on the table at the vet) and didn’t want to do blood work today.

at this point the vet wants to do an ultrasound next week ( Thursday, July 27) and get a urine sample and blood at that time.

Misty is eating well and I have her in a small space so that she isn’t far from the litter box. Other than being in the small space and not being able to wander she seems happy and isn’t crying or meowing much. Yesterday after the vet, she peed very small amounts about 8- 9 times - up until I went to sleep.

Overnight ( between 11:00 and 8:00) she peed 3 times and the volume, based on litter blobs seems larger.

I would love to know your thoughts and if there is anything else I could consider? Also, does it make sense to wait 9 more days considering her history of kidney disease and uti.
Thank you so much. Barbara.

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Dr. Jeff

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Hi Barbara!
I'm sorry to hear about Misty's health challenges.

But her BEAM says that she's confident that she'll overcome them .

She can then get even stronger and more resilient than ever (this is actually a common scenario!).

Now she just has to convince you that she's OK....
is anything else I could consider?
Yes!
Also, does it make sense to wait 9 more days considering her history of kidney disease and uti.
I have an appointment right now then will finish this post after it. In the meantime, perhaps just pet and play with her to get her to purr and squint happily!

@Dr. Jean Hofve?
 

Dr. Jeff

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Hi again Barbara!

I wonder if Misty had a history of other UTIs prior to 10/22?

Can you think of any emotional events associated with her urinary symptoms?

The best thing pet parents can to help kitties with UTI symptoms (also called FUS, FLUTD, FIC, etc.) is to increase their environmental enrichment and engagement, e.g play with them more.

Vets have found that urinary symptoms in cats are super common as bladder symptoms is a big way that they manifest their stress.

There are so many potential causes and symptoms, that we now even have a new name for urinary problems in cats. "Pandora Syndrome":


In addition to increasing her environmental enrichment, add even more happiness to her life:


Also, regardless of the manifestation though, you may want to consider upgrading her diet (fresh food is best, and NO dry food).

Have you done the HA! 101 course?

There are also tons of other resources to read and watch including the recent Empower Hour! webinars focused on helping UTIs and kidney problems.

There are many actions such as adding vitamin C, cranberry, mannose, cornsilk, etc.

You can also schedule a 15 minute Holistic Medical Decision Making coaching call with Dr. Christina or myself this week.

Also, does it make sense to wait 9 more days considering her history of kidney disease and uti.
Yes, it's fine to wait. She might even be better long before that. Her body is designed to re-balance (happiness helps)!
 

BarbaraPB

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Hi again Barbara!

I wonder if Misty had a history of other UTIs prior to 10/22?

Can you think of any emotional events associated with her urinary symptoms?

The best thing pet parents can to help kitties with UTI symptoms (also called FUS, FLUTD, FIC, etc.) is to increase their environmental enrichment and engagement, e.g play with them more.

Vets have found that urinary symptoms in cats are super common as bladder symptoms is a big way that they manifest their stress.

There are so many potential causes and symptoms, that we now even have a new name for urinary problems in cats. "Pandora Syndrome":


In addition to increasing her environmental enrichment, add even more happiness to her life:


Also, regardless of the manifestation though, you may want to consider upgrading her diet (fresh food is best, and NO dry food).

Have you done the HA! 101 course?

There are also tons of other resources to read and watch including the recent Empower Hour! webinars focused on helping UTIs and kidney problems.

There are many actions such as adding vitamin C, cranberry, mannose, cornsilk, etc.

You can also schedule a 15 minute Holistic Medical Decision Making coaching call with Dr. Christina or myself this week.


Yes, it's fine to wait. She might even be better long before that. Her body is designed to re-balance (happiness helps)!
Dear Dr. Jeff, thank you for all of your support, resources and ideas. Misty first had a UTI earlier in September of 2022 which coincided with my husband and I going away. We had cat sitters coming in 2x a day to feed and play with her. She's resting comfortably and seems to be holding her urine a little longer today. I've been singing to her which she really likes and purrs as I'm singing. It was something you had mentioned to me on one of our calls. I will continue to play as much as we can.

Is there a certain type of D-Mannose that you like?

@Dr. Jeff

Thank you so much again.
Barbara
 

Dr. Jean Hofve

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Hi Barbara! Fortunately the labwork indicates *very* early and mild kidney disease, with a little liver stress (liver is a big sympathy organ and tends to get out of sorts when other organs are off).

In my experience, often with these old kitties there are calcium oxalate stones in the kidneys, and little pieces will flake off and cause pain and damage through the ureters, bladder, and urethra. Not much you can do about it other than address pain and stress. Flower essences would be good on top of Dr. Jeff's suggestions. With her BEAM so strong, and the problem so new, I think ultrasound is premature.

Definitely moving more fluid through the kidneys and bladder will help, so wet food only (with a little added water)--no fish flavors for now--is the ticket.
 

BarbaraPB

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Thank you @Dr. Jean Hofve. I appreciate your sharing about the high liver enzymes and how to support Misty if she has additional pain or discomfort.

I’m also wondering if you ever see connections between high liver enzymes and gallstones?

Misty also has a gallstone that was identified in early October 2022 when she was hospitalized for a few nights. I will try to find the report and attach it.

My conventional vet is looking to explore the connection between the two ( gallstone and liver enzyme) on the ultrasound that I mentioned above. The liver enzymes have increased more ; although I wonder if that has to do with stress she’s experienced because of her current symptoms.

I have attached Misty’s most recent blood work that was drawn this week. Surprisingly her creatine numbers declined while her liver enzymes increased more.

finally , there is no update on the urine culture and sensitivity. I have started to give misty some micro C and D mannose for her urinary symptoms and will also start cranberry. I have to do it slowly because she’s quite finicky about adding things too quickly to her food. Misty seems happy , is purring and eating. Her urine output is still less than her Normal. Thank you again for any additional thought. Barbara



@Dr. Jeff

@
 

BarbaraPB

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Attachments

  • MISTY-PLESHKO-BERGER-2023-07-20-1643.pdf
    330.8 KB · Views: 2
  • Misty ultrasound .pdf
    226.2 KB · Views: 2

Dr. Jean Hofve

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So no kidney stones (some mineralization), that's excellent, whew! They can be such a problem! I don't think the gallstone is a big factor in liver enzymes. It all looks pretty good except her bladder shows signs of chronic/recurrent UTIs. They're not always symptomatic in cats. So that's where to focus now. I agree mannose is fine, slippery elm would be helpful too, and fluids-fluids-fluids!
 

BarbaraPB

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So no kidney stones (some mineralization), that's excellent, whew! They can be such a problem! I don't think the gallstone is a big factor in liver enzymes. It all looks pretty good except her bladder shows signs of chronic/recurrent UTIs. They're not always symptomatic in cats. So that's where to focus now. I agree mannose is fine, slippery elm would be helpful too, and fluids-fluids-fluids!
Thank you for your thoughts and response!
 

Dr. Jeff

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Hi Barbara!

She's resting comfortably and seems to be holding her urine a little longer today. I've been singing to her which she really likes and purrs as I'm singing. It was something you had mentioned to me on one of our calls. I will continue to play as much as we can.
Great work!!

I'll also take a look at your uploads as soon as I can.
 

Dr. Jeff

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Hi Barbara!

Thanks for sharing the additional info.

Wonderful improvement in her creatinine (the main kidney enzyme) since the April test!
I've been singing to her which she really likes and purrs as I'm singing. It was something you had mentioned to me on one of our calls. I will continue to play as much as we can.
Fantastic!! Try to keep it up. Are you seeing any immediate effects on her BEAM?

I'd be suspicious that there may indeed be some liver inflammation associated with the stone. I also agree with Dr. Jean that her bladder is the place to focus.

The more you can enrich her life with singing, dancing, purring and play, the better IMHO.

Are you using a phosphorus binder? What is she eating, and how is her appetite?
 

BarbaraPB

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Hi Barbara!

Thanks for sharing the additional info.

Wonderful improvement in her creatinine (the main kidney enzyme) since the April test!

Fantastic!! Try to keep it up. Are you seeing any immediate effects on her BEAM?

I'd be suspicious that there may indeed be some liver inflammation associated with the stone. I also agree with Dr. Jean that her bladder is the place to focus.

The more you can enrich her life with singing, dancing, purring and play, the better IMHO.

Are you using a phosphorus binder? What is she eating, and how is her appetite?
Thank you @Dr. Jeff and @Dr. Jean Hofve We are continuing to focus on enriching Misty’s life. In addition to your ideas she loves being brushed and purrs like crazy during this time.

She take petsiac and aminivast. I don’t believe these are phosphorus binders. Is this something you like in cats?

She’s eating purely canned commercial food. An upgrade from also having dry food. I’ve been able to get her to eat higher quality freeze dried snack. She refused the cooked chicken I made for her. Although I am thinking about trying again as I know it’s important.

There’s been a new development in that the recent urine culture done at the time of blood work did grow bacteria. I will attach the lab result.

Antibiotics were recommended and in addition I am continuing the D-Mannose since we had already started and I felt it was positive for her.
I’m doing a supplemental dosage ( 1/2 the scoop) as opposed to a therapeutic dosage. If you disagree with my thinking please advise.

The ultrasound was done yesterday and I don’t yet have updates.

The vet told me Misty had the biggest poop she has ever seen and described it as being like a dogs size poop. and then she was in and out of the box after as I had reported I saw at home. She’s not pooping as regularly as she was and is skipping days Eventhough she’s eating. I’m not sure what that is and if perhaps the vitamin C will help to create more balance in that area. If you have other ideas please advise?

Many thanks again for your help and support. Also, I’m writing now because I didn’t see an email notification. Barbara

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Dr. Jeff

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Hi Barbara-
I don’t believe these are phosphorus binders. Is this something you like in cats?
No, the Petsiac and Aminavast are not phosphorus binders.

Yes, phos. binders can be very useful for managing kidney issues in both dogs and cats. If I recall correctly, Misty's phos. was not elevated, so it would be great to start now with something like this:


She’s not pooping as regularly as she was
f perhaps the vitamin C will help to create more balance in that area. If you have other ideas please advise?

Yes, the vit C can help both her poops as well as her immunity and the bacteria. Perhaps keep increasing the vit C until her stools start to loosen.

Also, it's super helpful to add additional fluids to her food to help her defecate more frequently.

@Dr. Jean Hofve may have other ideas (and she has a great kitty constipation article on littlebigcat.com).
 

BarbaraPB

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Hi Barbara-

No, the Petsiac and Aminavast are not phosphorus binders.

Yes, phos. binders can be very useful for managing kidney issues in both dogs and cats. If I recall correctly, Misty's phos. was not elevated, so it would be great to start now with something like this:




Yes, the vit C can help both her poops as well as her immunity and the bacteria. Perhaps keep increasing the vit C until her stools start to loosen.

Also, it's super helpful to add additional fluids to her food to help her defecate more frequently.

@Dr. Jean Hofve may have other ideas (and she has a great kitty constipation article on littlebigcat.com).
Thank you!
 

Dr. Jeff

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You're welcome Barbara!
 

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