complicated flutd....any ideas?

RE: complicated flutd....any ideas?

Anthony Todd — Tue, 05 Apr 2016 10:26:50 GMT

[quote user="Rob Davis"] I do not think you have anything to gain by taking this case on...[/quote]

Probably not but the cat might....

Still waiting for an answer as to whether the really cat has "cystitis". Sounds to me as if it may just be psychological inappropriate urination and nothing wrong with the bladder at all.

I've had cats that pee on stranger's clothing if a new male [human] comes into their environment, or reacting to the presence of other cats, and these were either females or castrated males. [spraying on the curtains too]

RE: complicated flutd....any ideas?

Rob Davis — Tue, 05 Apr 2016 09:46:53 GMT

[quote user="Deborah Anwyl"] The previous vets have done a LOT of work up. They have ruled out infection, crystals and structural issues and even went as far as scoping her but found nothing. They managed her on regular metacam which she does respond to. The owner (who is lovely) wanted a second opinion as the bouts are becoming more and more frequent.[/quote]

As the second opinion vet, I would be inclined to advise that the previous vets appear to have done a very thorough job and that I agree with their management of the case. I would try to encourage the owner to return to the original vets. I do not think you have anything to gain by taking this case on...

RE: complicated flutd....any ideas?

Anthony Todd — Thu, 31 Mar 2016 16:40:22 GMT

Still wondering how the diagnosis of "cystitis" was arrived at as the urine is normal?

Has the urethra/vulva been scoped etc. could be a grass-seed or some foreign body, that's as the urine is apparently normal in a cat showing signs of "cystitis"?

BTW, I think it's better to give a normal dose of steroid [dexameth?] by injection and assess because you'll get an obvious response within 24 hrs or not and then you can continue with a longer-acting regime.

RE: complicated flutd....any ideas?

Martin Atkinson — Thu, 31 Mar 2016 14:34:15 GMT

[quote user="Kate Richardson"]Half the vets I seem to speak too are scared stiff of metacam[/quote]Given 3 of the first 6 cats I put on it developed severe renal failure (they were all blood tested before and had normal renal function) I'd be one of those. I now give it very sparingly and only advise giving 'too effect' not prophylactically as I might in dogs. I prefer Onsior and use it on my old cat with OA (he has IRIS stage 2 CKD) as and when he looks stiff and painful, the tablets are very palatable and he eats them like treats.

RE: complicated flutd....any ideas?

Kate Richardson — Thu, 31 Mar 2016 14:20:39 GMT

[quote user="robloxley"]

I think you have addressed that stress is a major factor and may not be easy to fix, a good behavioural assessment at home and advice would really be worth the owners investing in.

I'd weigh up the benefits the metacam gives this cat against the potential risks, being aware that judicious doses may not necessarily be detrimental and if you can improve the cat's quality of life now that may be a bigger factor than the worry of potential renal effects in the future.

Have you tried amitryptiline or similar?

[/quote]

Absolutely agree- if metacam works in this cat then intermittent use when she gets a flare up would be safe as long as the cat is eating and bright otherwise. Half the vets I seem to speak too are scared stiff of metacam, and the other half have no concerns! There is actually some evidenec to show it can be beneficial in renal disease as well, so I wouldn't not use it just because the cat has renal disease (I assume USG is low?) But well worth continuing to monitor urine cultures as well now if cat has recurrent idiopathic cystitis and renal disease as sub clinical UTIs may be more frequent, so I'd adv a culture q3months even if no clinical signs of cystitis.

I haven't had much success with calmaid etc clinically, and if difficult to medicate, this adds to the stress. Amitryptilline would be where I would go along with increasing water intake as much as possible, Feliway and environmental modifcation and a very frank chat with the owners about stress levels, someone might just have to give.....

RE: complicated flutd....any ideas?

Anthony Dennison — Thu, 31 Mar 2016 13:29:58 GMT

[quote user="Deborah Anwyl"]We have tried calmex, [/quote]

Have you tried Kalmaid? It's fish flavoured, most cats I've put it on tolerate it well. 1 pump twice a day to start with, either in the food or on the back of the paw so they lick it off whilst grooming.

I swear by the stuff.

RE: complicated flutd....any ideas?

Busybee — Wed, 30 Mar 2016 20:02:58 GMT

[quote user="Deborah Anwyl"]Given the renal situation I have had a discussion with the owner regarding nsaids and renal disease and the owner is not keen to continue this route so we are currently trialling her with low dose preds.[/quote]

I have a cat that was on long term Metacam for spinal and hip OA but was then discovered to have CKD. I discussed with the owner and we decided to carry on with the Metacam at a half dose and introduce Semintra for the CKD. He has been on this regime for around 18mo and there has been very little observable (clinical or on blood/urine work) deterioration of his CKD!

It's not a full article but this may help - it is, as my case is, about DJD + CKD rather than cystitis.

http://www.ncbi.nlm.nih.gov/pubmed/21906984

RE: complicated flutd....any ideas?

Anthony Todd — Wed, 30 Mar 2016 16:54:02 GMT

[quote user="Deborah Anwyl"]8yo FN Birman with frequent signs of cystitis.[/quote]

What signs are she showing, when, where, frequency etc.? Blood/cells in the urine? Water/fluid intake etc.? pH and SG??

Usually/always with "cystitis" there are some changes or abnormality in the urine?

Is it just a dysuria?

RE: complicated flutd....any ideas?

Utlendigur — Wed, 30 Mar 2016 14:38:30 GMT

Is there any way they can divide up the house so the cats don't have to interact eg one upstairs and one downstairs. May also be worth asking re litter trays - are there enough and in quiet areas. Similarly with food/water - could they feed the cats in separate areas of the house if not doing already. Has she always been aggressive/stressy ie was she that way before the other cat came on the scene and/or before the FLUTD started (pain related aggression?)

May also be worth repeating the culture if it was done a while ago and the problems are getting worse just in case she's developed a UTI. BP measurement would probably be helpful (but probably impossible!)

RE: complicated flutd....any ideas?

Deborah Anwyl — Wed, 30 Mar 2016 14:33:53 GMT

Thanks for the replies guys.

She has been on the feliway cystease since November. her urine has been cultured form cysto several times and always negative. Renal results show elevated urea/creat and sdma and when she landed at out of hours for an unassociated issue earlier this year they got their imaging specialist to scan her.

We have tried calmex, she doesn't like the taste of it which is why we are on the cystease as it can be disguised in her food. I trust this client to be telling the truth but we have had a realistic discussion re the causes of stress.

RE: complicated flutd....any ideas?

Martin Atkinson — Wed, 30 Mar 2016 14:21:55 GMT

How long has she been on the Feliway Cystease? It may take a while for the benefit to become apparent. How much can you rust the client to comply and even not be the root cause of its psychological issues? You say that you've ruled out infection - did you culture a urine sample? If it is CKD (its a bit young for that so are you diagnosing this on something other than azotaemia which may be from a different issue?) cats with renal disease often have a concurrent pyelonephritis that may take months to resolve on antibiotics. If you truly have a stress related idiopathic cystitis then you could try Calmex or even Selegiline although the latter has fallen out of favour recently.

The bottom line, if it is idiopathic cystitis, then it is self limiting and the cat is not going to get worse but if the owner cannot accept this then the cat may even be better re-homed. Either way if you can't resolve it you're likely to lose the client!

RE: complicated flutd....any ideas?

Rob Loxley — Wed, 30 Mar 2016 13:59:56 GMT

I think you have addressed that stress is a major factor and may not be easy to fix, a good behavioural assessment at home and advice would really be worth the owners investing in.

Have you tried amitryptiline or similar?