FLUTD in Veterinary Times

Re: FLUTD in Veterinary Times

Anthony Todd — Fri, 21 Feb 2014 12:28:50 GMT

[quote user="Martin Atkinson"]Can't argue much [/quote]

Ok, one "stress-related" until proved otherwise, or until it's full of crystals next time. [I'll bet you're not game to put it on the new Hills diet....]

Did you fix the previous episode? What was that one?

Re: FLUTD in Veterinary Times

Martin Atkinson — Fri, 21 Feb 2014 11:45:40 GMT

[quote user="Anthony Todd"]Can't argue much unless [grasping at straws] it's just inappropriate urination per se? Which is, in this case, is obviously stress related. Also look at the SG; surely should be on wet food given it's previous struvite history [er, or oxalate, given the pH].[/quote] No there is obvious increased attempts at urination/dysuria. The Urine SG has been taken on board and it is now on moist Obesity Control diet. The previous obstructive LUTD was several years previously.so no direct connection.

Re: FLUTD in Veterinary Times

Anthony Todd — Fri, 21 Feb 2014 11:24:04 GMT

[quote user="Martin Atkinson"]This would appear to be a stress related idiopathic cystitis and IME the majority of cats presenting with this and FLUTD are stress related.[/quote]

Can't argue much unless [grasping at straws] it's just inappropriate urination per se? Which is, in this case, is obviously stress related. Also look at the SG; surely should be on wet food given it's previous struvite history [er, or oxalate, given the pH].

Maybe a urethritis after the traumatic prior treatments [often dodged in the statistics]..

Why, if Hills say it's "stress related" is it spun off struvite control? Why not a separate food without all the crystal preventing chemicals?

Re: FLUTD in Veterinary Times

Martin Atkinson — Fri, 21 Feb 2014 11:12:01 GMT

I saw a cat yesterday that fitted the classical stress pattern but also the FLUTD pre-dispostion to a tee. It is an obese, middle aged, sedentary, neutered male. It had previously been diagnosed with FLUTD due to struvite crystals and treated with RCW urinary control diet with no relapses and has been on dry Senior Consult diet for a while. Recently it has been moved from Madrid to Barcelona then to here where it has been in several different homes, currently a one roomed rented bed-sit.

It presented with inappropriate urination, not using the tray and apparent dysuria. The bladder was empty but given the previous history the cat was catheterised and had a pneumocystogram on which there was NAD. The urine SG was 1.070, pH 6.5 and no crystals were seen and no evidence of urinary tract infection.

This would appear to be a stress related idiopathic cystitis and IME the majority of cats presenting with this and FLUTD are stress related.

Re: FLUTD in Veterinary Times

Anthony Todd — Fri, 21 Feb 2014 09:56:47 GMT

Don't worry Hills have introduced c/d urinary stress.

Go figure.

Told you it was all dietary.....

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 20:07:38 GMT

[quote user="tess"]Both- it's hard to tell the difference sometimes. I think we miss a lot of stressed cats. One owner I dealt with has 5 cats, [/quote]

...etc

This is a classic example of what I've said above in that this cat is obviously on a limited water regime because of the undisputed environmental conflict and stress but I say it's the water restriction that causes the problem [which is obstruction or just dysuria??]

I completely agree about the fastidiousness of cats and food or water. some prefer to drink it out of flower pots and prefer standing water with a dusty film on top!!

Same with urination, change the cat litter; look at them sideways and they'll go under the bed and not pee for hours then follow my flow chart as previously shown..

I do think there are a lot of stressed cats 'cos they can't drink or pee how they like, when they like and where they like.....and so they get FLUDT.

I think I can show that it is the food and not the water [except perhaps the posh Badoit] which is the source of the minerals, which at least someone now mentions in passing!

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 19:54:33 GMT

"Struvite crystals are not that common in obstructed FLUTD cases, and no more so than in average cat urine."

I would agree that struvite crystals are not that common in obstructed cats now or not as common because the manufacturers have reduced the Mg content of the food and adjusted the pH to < 7, hence the sudden surge or also "discovery" of oxalate.

If you said "any crystals" etc are not that common then I'd say goody but I think the crystal presence is being glossed over for reasons which I cannot fathom.

Some labs even say their presence is "normal"....

"If I do cysto on a cat and look at the fresh sediment within 15mins, I rarely see significant numbers of struvite crystals (obstructed or not)"

These are all primary FLUDT cases ie never been obstructed or unblocked for any reason at all???

Usually this distinction is never made, which is important, because the incidence of urethral stricture or crystals wedged into the urethral wall is very high following even "gentle" catheterisation.

"if I leave the urine sitting out and then repeat the exercise they find lots more"

Um, my point exactly, if you have crystals in a sample doesn't that mean you've got a saturated solution and any change in the mileau may cause excessive precipitation leading to obstruction, or at least dysuria.

That combined with a urethral stricture and inflammatory debris to form the so-called plug proceeds to an obstruction.

I'm no physicist but I understand multiple factors ionic, pH temperature can make precipitation occur instantaneously.

"I think the "water-drinking-fountain", for instance, has been largely debunked"

Yes, after the debacle of the Go Cat epidemic the advertisements had a water bowl beside the go-Cat bowl.. Have you ever been able to make a cat do anything except attack you if it didn't want to??

"siginficant urine dilution"

Dunno whether they are or not but I suggest that the difference between precipitation and solution is a fine line and any dilution may be enough?

Jackson [sorry to exhume his work] did refer to cats as "stone-formers and non-stone formers" as some of his experimantal cats could consume loads of Mg++ and never form crystals, others at the drop of a hat.

As an aside, when the Rich and Fabricant "viral aetiology" was at it's height what to you think the food manufacturers did with any cat that formed crystals or obstructed? Obviously had the virus so were culled thus producing a strain or colony of lab cats that would eat Go-Cat until it came out of their ears without obstructing......

Mine "And often the treatment involves "steroids" [to reduce the inflammation etc] which is a nice diuretic"

Er, um, it is in dogs and, er, I've always thought it probably was in cats and it is listed "increased thirst and urination" as a short term side effect in the cat.

Trouble is, and being cynical, it is likely that vets treat FLUDT condition with drug X and give advice involving diet change, water consumption measures, exercise advice and drug Y and an antibiotic just in case and a steroid and a bit of B12 but still label it stress related and say the crystals round the end of the penis aren't significant anyway......!!

I just wish they'd all 'fess up and admit to all the measures they advise, but don't mention.

Re: FLUTD in Veterinary Times

tess — Sun, 09 Feb 2014 19:34:32 GMT

Also this cat has never had any evidence of crystals in its urine, which is often the way in cases like this

I would only use a urinary diet in cases where a fresh sample was heaving with crystals.

Re: FLUTD in Veterinary Times

tess — Sun, 09 Feb 2014 19:22:50 GMT

[quote user="Anthony Todd"]

[quote user="tess"]Increasing the water intake seems to help with bladder function somehow[/quote]

So do you do this in cats with "stress related" or "ideopathic" FLUDT?

[/quote]

Both- it's hard to tell the difference sometimes. I think we miss a lot of stressed cats. One owner I dealt with has 5 cats, one of whom develops cystitis at the drop of a hat. When she started to really examine their behaviour she realised they fell into 2 separate groups. Having only one water bowl was clearly not appropriate in this case, because stress was increased the cat having to share a bowl with the other social group .It was also one with chronic constipation-that's much better now, and I think she was inhibited from drinking previously.

Cats can also be very particular about what they drink from- large, small, deep, shallow, running, still etc. It's certainly going to do no harm by offering multiple choices and if people are concerned about minerals then it can be filtered.

Re: FLUTD in Veterinary Times

John Flynn — Sun, 09 Feb 2014 18:59:30 GMT

Hi Anthony,

I've not read all the posts, but hopefully have got the gist of your argument OK.

I always like alternative views challenging "accepted wisdom", but I'm really not convinced here re significance of struvite (of course that could jsut reflect the population of cats I see and the local drinking water/diets etc).

My take:

Struvite crystals are not that common in obstructed FLUTD cases, and no more so than in average cat urine.

I have a minor interest in cat urine(!), so have looked at a reasonable number of samples over the years.

If I do cysto on a cat and look at the fresh sediment within 15mins, I rarely see significant numbers of struvite crystals (obstructed or not); if I leave the urine sitting out and then repeat the exercise they find lots more, but I can't see them being of any major clinical significance if dissolved at cat's bladder temperature?

On the "diluting the urine" front - makes loads of sense, but practically I'm a little skeptical as to how much of a difference suggested measures really make to urine concentration. I think the "water-drinking-fountain", for instance, has been largely debunked, and the suggestion that I've read numerous times that one wishes to increase the cat's drinking so that the urine refractivity reaches "1.020" (SG scale on medical refractometer) sounds a little far-fetched to me - I don't think I've ever seen a non-PUPD cat with urine that dilute and would question whether folks are actually achieving siginficant urine dilution with the various measures suggested?

[quote user="Anthony Todd"]And often the treatment involves "steroids" [to reduce the inflammation etc] which is a nice diuretic[/quote]

In cats?

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 17:09:13 GMT

[quote user="glen mcintosh"]But wouldn't that still make "stress" a predisposing cause of obstruction in what could be a multifactorial disease?[/quote]

Ok, it depends where you want to start. If you go down that road then:

Chinese New Year -> Fireworks -> panic -> stress -> hiding or compulsary confinement -> peeing restriction -> urinary retention -> precipitation of "crystals" -> dysuria and/or obstruction -> stress related FLUDT

Dog outside, new baby, new cat or whatever in and then you've got -> stress -> hiding or confinement -> peeing restriction -> urinary retention -> precipitation of "crystals" -> dysuria and/or obstruction -> "stress related FLUDT"

The only different one is summer or hot weather when you've got "normal" water intake but excessive water loss -> deydration [somewhat] -> precipitation of "crystals" -> dysuria and/or obstruction -> "ideopathic" related FLUDT

Apart from that you've got high levels of Mg++ or oxalate in the diet then you go straight to -> precipitation of "crystals" -> dysuria and/or obstruction -> "ideopathic" related FLUDT

All these scenarios can be modified or prevented by diluting the urine which, I suspect is always ancillary advice as in the marmite example or wet food advice.

Posters seem rather reluctant to confirm or deny that this is part of their advice, but my bet it is....

Add to that the ploy of the manufacturers to add ammonium chloride to the diet to change the pH in the urine thus preventing struvite precipitating anyway until that produces oxalate precipitation which bit them right in the bum......

And often the treatment involves "steroids" [to reduce the inflammation etc] which is a nice diuretic, crystals redissolved in dilute urine.......

But it's actually all "stress" now of course, which I think is total baloney.....

Re: FLUTD in Veterinary Times

Glen McIntosh — Sun, 09 Feb 2014 16:39:27 GMT

[quote user="Anthony Todd"]But the cat's are either kept indoors or so freaked out that their usual peeing patterns are altered ,or just stopped, leading to urinary retention and crystal precipitation. As we all know cats are very very particular when it comes to peeing![/quote]

Ok, I'd buy that explanation too.

But wouldn't that still make "stress" a predisposing cause of obstruction in what could be a multifactorial disease?

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 16:16:49 GMT

[quote user="mariette asselbergs"]

[quote user="Francisco Gomez"]RMB diet, marmite, one special brand of bottled water... Is this a homeopathic thread?

[/quote]

Not homeopathic dosis! Its incredibly concentrated and salty. Its just because cats like yeast (extracts) and this will make them thirsty!

Mariette

[/quote]

Gee FLUDT is really well understood.....

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 13:07:38 GMT

[quote user="glen mcintosh"]I checked the records for the previous 2 years CNY weeks and there is also a similar spike, both for the day and night shifts.[/quote]

Yep, that sure happens, also in hot weather, which is where the "stress" idea is reinforced. But the cat's are either kept indoors or so freaked out that their usual peeing patterns are altered ,or just stopped, leading to urinary retention and crystal precipitation. As we all know cats are very very particular when it comes to peeing!

Very convenient for the stress protagonists but embarrassingly bad science by people who should know better.

Re: FLUTD in Veterinary Times

mariette asselbergs — Sun, 09 Feb 2014 13:03:22 GMT

[quote user="Francisco Gomez"]RMB diet, marmite, one special brand of bottled water... Is this a homeopathic thread?

[/quote]

Not homeopathic dosis! Its incredibly concentrated and salty. Its just because cats like yeast (extracts) and this will make them thirsty!

Mariette

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 12:59:04 GMT

"???? Boddingtons ....."

I firmly felt you weren't "rank and file", and would surely only drink "biere", just shows how wrong impressions can be.....

It's Badoit at 85 whatevers with Evian at 26 and Perrier at 3.4 etc. Thames water told me their's was 14, I think from memory but their site won't tell me and they talk about high Mg in their hard water so I'd check locally if you think it's relevant.

Re: FLUTD in Veterinary Times

Glen McIntosh — Sun, 09 Feb 2014 12:54:24 GMT

[quote user="Anthony Todd"]I cannot believe that any scientist would link stress to the cause of urinary obstruction[/quote]

Initially when I read your post I would have agreed whole heartedly(I don't get the Vet Times any more, but it sounds like an interesting article).

I can beleive the statistic that 75% of FLUTD cases were associated with stress, at least in male cats, but around about 50% of the female cats presenting with cystitis symptoms have had a documented uti in my experience.

But in cases of urinary obstruction I would have said, anectdotally, that 90% of cases were crystals, 9% were stones and 1% were something else. I wouldn't even have considered stress as a factor.

Then I thought about it a bit more, and was thinking about the past 7-10 days during which time I have seen an unusually high number of cats with urethral obstructions. During this period I have seen 1 or 2 cases per night, instead of the usual say 1 - 2 cases per week.

The last week or so has been Chinese new year. This week long event is bigger and more important for the chinese than Christmas is to most westerners. For the rest of the year most hong kong cats live in their owner's tiny high rise apartments, leaving only to come to the vets or the cattery when the owner goes on holidays. Life for most hong kong cats is, well, pretty boring, but I suspect thats how the cats like it.

Then along comes Chinese new year. The tiny flat fills up with the outlaws coming over for celebrations, all getting very loud and drunk. The neices and nephews are there chasing the cat and pulling on its tail. There's fireworks. There's the incessant very loud drum banging and people running around in dragon costumes.

For many cats I would imagine that it is enough to tighten any number of sphincters, not to mention urethral tone.

I checked the records for the previous 2 years CNY weeks and there is also a similar spike, both for the day and night shifts.

Maybe there is something in it?

Re: FLUTD in Veterinary Times

Francisco Gomez — Sun, 09 Feb 2014 12:44:26 GMT

RMB diet, marmite, one special brand of bottled water... Is this a homeopathic thread?

Re: FLUTD in Veterinary Times

Malcolm Ness — Sun, 09 Feb 2014 12:39:22 GMT

[quote user="Anthony Todd"]BTW one brand of bottled water, beginning with B is high in Mg++.....[/quote]

???? Boddingtons .....

Re: FLUTD in Veterinary Times

mariette asselbergs — Sun, 09 Feb 2014 12:38:53 GMT

I have only started to advise this in the last 8 months, and I haven't seen any of them back, but I may try to compare a bit from our practice records since not all vets recommend this.

Mariette

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 12:31:09 GMT

[quote user="mariette asselbergs"]Give the cat a half teaspoon of marmite over its food to increase drinking.[/quote]

I hope Marmite isn't high in Mg++, or oxalate, that's all, but anything that increases water consumption is good [table salt has Mg++ to prevent clogging....] and the Mg++ is strictly monitored by Thames water, to answer an earlier comment. BTW one brand of bottled water, beginning with B is high in Mg++.....

I think Whiskas does cat milk which I think is low in Mg++ and is less likely to give diarrhoea.

But are you, or does everyone, advise some sort of device to increase water consumption in their cases of "stress related" or "ideopathic" FLUDT, which nobody seems to want to clarify?

[Sorry about the RMB intrusion]

Re: FLUTD in Veterinary Times

mariette asselbergs — Sun, 09 Feb 2014 11:38:58 GMT

"to say that currently no diet change is ever given, nor is ever necessary, in cases of FLUDT?"

I picked this up from a colleague and have used the advise ever since:

Give the cat a half teaspoon of marmite over its food to increase drinking.

Like the GP telling you to drink some extra cups of tea. And most cats seem to like the stuff!

Mariette

Re: FLUTD in Veterinary Times

Tom Lonsdale — Sun, 09 Feb 2014 02:10:03 GMT

[quote user="Anthony Todd"]

"Putting Feline Lower Urinary Tract Disease in Context"

Sorry Tom we saw "blocked cats" long before any processed diets particularly those fed on high Mg++ diets like fish so it's got absolutely nothing to do with the "naturalness" of the diet except that some "natural diets, mainly meats like chicken are low in Mg++.

[/quote]

Sorry Tony, I'm not quite as old as you so can't remember the pre-junk food days.

But no matter, I think you misread my article. I was barely if at all referencing the ingredients of a natural diet.

A natural diet provides:

a) Nutrients in the most easily assimilable form without creating inflammatory responses.

b.) Necessary texture to clean the teeth and ensure no chronic massive open wound in the mouth (aka periodontal disease).

c.) Mental stimulation and production of endorphins which tone the immune, neurological and hormonal systems.

d.) Probiotics in the form of appropriate microorganisms ensuring bowel health and no subclinical IBD.

If Oliphant Jackon had lived I'm confident he would have surrendered his preoccupation with magnesium which appears to be one small bystander ingredient. I hope and suspect he would be more persuaded by the cascade of cytokines and matrix metallo proteinases flooding the systems of cats denied a, b, c and d. He would, I suspect, have acknowledged that inflammation is likely the prime determinant of FLUTD, just as human medical people now acknowledge the prime importance of inflammation in triggering heart attack, stroke, Alzheimers, arthritis, diabetes, etc and etc

[quote user="Anthony Todd"]Remember 6 penneth of cat's meat from the butcher,[/quote]

Sorry, no a, b or c in this. Possibly a few faecal organisms helping out with d. the probiotics. In fact to this day, we see some of the worst putrid, rotten mouths in raw minced meat fed cats. It starts at three weeks of age when cutting the teeth. Immature immune systems stressed to the max when they most want/need to chew. Another bout of severe gum disease at time of cutting permanent dentition and the scene is set for the litany of immune/inflammatory induced diseases afflicting the world's cats.

It's twenty years since the JSAP letter was published. I hope it won't be another 20 years before vets accord the role of inflammation the attention it deserves.

All the best,

Tom

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 01:06:47 GMT

[quote user="tess"]Increasing the water intake seems to help with bladder function somehow[/quote]

So do you do this in cats with "stress related" or "ideopathic" FLUDT?

Re: FLUTD in Veterinary Times

Anthony Todd — Sun, 09 Feb 2014 01:03:45 GMT

"Putting Feline Lower Urinary Tract Disease in Context"

Remember 6 penneth of cat's meat from the butcher, which was the staple diet of cats in NZ and, I suspect the UK.

We saw massive obstruction with teaspoons of struvite in some stone-formers on purely meat.

Dried food was about 10 years away.