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Dr. John
Dr. John, Small animal veterinarian, ER vet
Category: Cat Veterinary
Satisfied Customers: 1205
Experience:  significant surgical and medicine background, currently working as emergency clinic veterinarian
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Our 11 year old neutered male has urinary tract problems and

Resolved Question:

Our 11 year old neutered male has urinary tract problems and recently developed hyperthyroidism which is being controlled by medication (felimazole/thymazole), but he has gone from ravenous to a very picky eater. We have cooked for him, provide ALMO natural cans and it is hit or miss. He seems to want a variety. He is also losing a lot of hair now so we just tried to add a supplement. Any recommendations on natural products rather than the recommended urinary health, often by-product laden foods? We also want to leave some dry food while we are at work because he is not eating enough wet and needs to gain weight. There is another cat in the house - female, same age, in good health and tend sot eat quickly then throw up. It would be so nice to be able to offer them the same foods. Would be very grateful for your recommendations.
Submitted: 1 year ago.
Category: Cat Veterinary
Expert:  Dr. John replied 1 year ago.

Dr. John :

Thank you for your question concerning Saber. How long ago was he diagnosed as hyperthyroid? What urinary symptoms is he displaying exactly?

Customer:

April 2012

Dr. John :

Okay thank you and has his levels been tested since, indicating that he is not over supplemented with the medication, making him hypothyroid?

Dr. John :

What urinary tract symptoms is he displaying?

Dr. John :

Are you there?

Customer:

For the urinary symptoms, he had a major operation and extended hospitalization in 2005 upon our arrival in Vienna Austria and (fistula). He has had two painful episodes recently which required attention and they were able to drain the urinary tract non-invasively.

Dr. John :

Sorry

Dr. John :

So he became obstructed and required a PU surgery I'm assuming? Was anything mentioned about making his genitalia essentially "into a female" for this urinary problem?

Customer:

He has had three blood tests in three months. He went from .90 to .73 to .29. We increased then decreased meds from 5 grams to currently 2.5 this week because of the leak of appetite problems.

Dr. John :

Just trying to figure out what exactly has been done thus far...

Customer:

yes, they made his genitalia into a female system zoo that he has not ever again been totally blocked. So we are trying to manage both problems. He has however developed painful crystals twice

Dr. John :

Okay understood

Dr. John :

Was he checked for infection during these recent episodes?

Dr. John :

Normally infection is not present, especially with younger cats, but infection becomes of much larger concern when gets get around 10+ years...

Customer:

sorry meds are 2.5 mg currently for the week to increase appetite. They started at .5 then up to 7.5, down to .5 and this week we were advised to lower the meds for a week to see if that helps increase appetite.

Dr. John :

Namely, a urine culture would have needed to be performed

Customer:

Not sure about a urine culture....

Dr. John :

2.5mg twice daily?

Dr. John :

or once daily

Customer:

Was twice daily but we just reduced yesterday to 2.5 once daily in am per french doctor's advice because of appetite.

Customer:

We've also noticed increasd thirst, spraying (out of box), and odor in urine. Lots of output.

Dr. John :

Okay, I'm thinking the thyroid has nothing to do with the appetite issues as of late, but it is more related to these urinary tract symptoms

Dr. John :

When is the last time he has had full blood work (not just checking thyroid levels)?

Customer:

I am not sure but I am looking at results from 8 february that say vet test and list ALKP, ALT, UREA, CREA, GLU and TP levels. Then there is a SNAP test below that seems to be the thyroid. So answer may be February but I am going through papers as I write.

Customer:

Yes, other two tests seem to be only SNAP (thyroid I guess) in April

Dr. John :

Okay - let me know if anything was done more recently concerning the values you mentioned above

Dr. John :

Okay

Customer:

27 FEB there is Lasercyte blood screening that seems comprehensive that shows more values than the ones listed.

Dr. John :

If I were to see Saber in the states, I would recommend the following, given his current symptoms...

Dr. John :

Yes that one includes blood counts

Dr. John :

Definitely a chemistry needs to be repeated to see if his increased drinking, increased thirst, and odorous urine have anything to do with kidney disease or diabetes

Dr. John :

His urine also needs to be cultured, and he needs to be started on a good broad spectrum antibiotic such as Clavamox or a flouroquinolone while the culture is pending

Customer:

what about nutrition. That is a real concern.

Dr. John :

He also needs an ultrasound (or at least x-ray) of his bladder to ensure he has not formed any actual stones in his bladder that cannot pass, even though he has had the urinary tract surgery (this is still possible)

Dr. John :

I will get to that, but that is not the pressing concern right now

Dr. John :

He has something else going on, guaranteed... The tests I mentioned will help you figure that out

Dr. John :

Additionally, his thyroid levels should not be monitored with a snap test

Dr. John :

This test is inaccurate and is acceptable for initially diagnosing the disease at best, XXXXX XXXXX monitoring therapy

Dr. John :

His blood needs to be sent to an outside lab, to get real numbers on this thyroid levels, then his dosages can be more accurately adjusted

Dr. John :

I personally like the commercial diets for cats that are aimed at urinary tract health because they increase water intake and acidify urine

Dr. John :

If you are looking for alternatives, you can add some salt to a standard diet and a urinary acidifier (such as methionine)

Dr. John :

However the MAIN goal for these guys is decreasing urine specific gravity

Dr. John :

This means achieving a more dilute urine

Dr. John :

If you can maintain a dilute urine, you can feed Saber anything

Dr. John :

Two things that help with this significantly are feeding ALL CANNED diet (total water intake daily higher with canned diets vs dry diets)

Customer:

We've tried a few. He's eaten off and on Royal Canine urinary - he likes the pockets but only off and on. We want to get some variety in his food so he is tempted to eat. We can order some alternatives on-line from US with a prescription.

Dr. John :

and encourage more water drinking - water fountains, tuna juice to water, chicken broth to water, etc

Customer:

Makes sense. How can we ensure dilute urine - is that through regular urine cultures (and is the oder a sign that it is not dilute -- or at least one of the signs)?

Dr. John :

But my concern at the moment is there could be something more to this going on (meaning underlying kidney disease, diabetes, stones in the bladder, or a true urinary tract infection) which a diet change is not going to help with any of these...

Dr. John :

The most accurate way is urine specific gravity

Dr. John :

Which is obtained from a refractometer (small handheld device)

Dr. John :

A small drop of urine is all that is needed to check

Dr. John :

Odor and color wouldn't be accurate ways to measure

Customer:

Yes, points well taken. I think we may seek out a hospital/clinic for these additional tests - or ask our vet to do them while we work on food issues, drinking, etc.

Dr. John :

We want a urine specific gravity UNDER 1.035

Dr. John :

Do you have any animal specialty hospitals in your area in France?

Customer:

OK - is this urine specific gravity test one that we can do to monitor more frequently?

Dr. John :

Also I have tried this for some of my more complicated/refractory cases, there is no evidence that it provides a strong benefit, but certainly doesn't hurt----

Customer:

More that likely. We are in Paris and I will look.

Customer:

Sorry - no evidence of strong benefit but can't hurt - to what were you referring there?

Dr. John :

Okay I'm sure Paris has something like this. With all of Saber's issues, an internist (internal medicine specialist of veterinary medicine) would be well suited for his continued care, so something you can look into

Customer:

Ah, the link. Got it.

Dr. John :

The link I sent above

Dr. John :

:-)

Dr. John :

So let's recap - because his decrease of appetite, increased thirst and urination, and urine smell concern me....

Customer:

Is it possible to get a prescription so that we can order food while we get these exams done? Ca we also get the little testing kit for the urine at a U.S. company?

Customer:

Sorry - I am attentive to your recap.

Dr. John :

If possible, get a true thyroid blood test to an outside lab, not a snap test. Make sure the test is about 6 hours following the pill administration for accuracy as well

Dr. John :

Have his blood chemistry repeated as well, and a urinalysis and culture performed on his urine

Customer:

OK - I will seek an internist at a clinic. Increase of fur loss has also developed

Dr. John :

Start him on an antibiotic in the meantime while waiting for results incase it is an infection, you will be ahead of the game

Customer:

6 hours, right - that's been the recommendation we have filled here.

Dr. John :

Have the bladder ultrasounded for evidence of stones that cannot pass (an internist can do this)

Customer:

got it. He has not had an ultrasound in a while.

Dr. John :

Switch to all wet diet and add things to the water to increase drinking, also consider a water fountain (cats like moving water for some reason and tend to drink more of it)

Customer:

OK on the water fountain. He drinks out of tub. W had a fountain once and his "sister" used to knock all the water out. We'll try again.

Dr. John :

As far as a script, it is illegal for me to write one without an examination of your pet unfortunately, but your current vet should be able to provide that for you without any issues. Urine testing at home isn't necessary, just bring an occasional sample to your vet for a specific gravity, once you have made the changes of an all canned diet and increased water consumption, to see how things are going

Customer:

My understanding on food is that it should be 60% protein and 40% veggies. Low PH and high acidity. Did i get that right and are there alternatives

Dr. John :

I typically use either Royal Canin SO or Science Diet c/d, either of those would be available in your area

Customer:

Understood. I have a scipt from the French vet but it id French and I am not sure US pet stores will accept it. I can go to French places for now - there just seem to be more options in the US.

Customer:

OK - I will continue him on those diets but I need to get something into him when he refuses that is moos, so I'll continue to cook chicken, fish, meat when he feels like it.

Dr. John :

The main goals of the diet is to increase water consumption and dilute urine

Dr. John :

There is much less emphasis on pH now, but it may still play a role, but depends on the stone type

Customer:

OK on the diet and roger the PH. Is the fur loss related do you think to malnutrition, hyperthyroidism or medical?

Dr. John :

For struvites, we want an acidifying diet that is magnesium restricted

Customer:

We'll get the tests and request antibiotics while awaiting them.

Dr. John :

Oh sorry yes forgot to address that...

Dr. John :

Is there bald patches, or just overall a lot of hairloss?

Customer:

Are there acidifying diets in human foods that can supplement and encourage him to eat when he is tired of the precrip food?

Customer:

Just a lot of hair loss. But increased. More than normal. We are full of fur from just a sitting and the hair comes easily when pulled.

Dr. John :

No, I wouldn't use human foods unless it is specifically balanced for a cat (they have very different dietary needs than people do, but there are online books however with recipes for a home cooked diet if you want to try this). More easily, I would just recommend a quality canned diet if he isn't eating the prescription, remember the main key is dilute urine, not as much the other things (pH, magnesium content, etc) that are present in the prescription diets. These things help, but aren't nearly as essential as the dilution.

Customer:

I am going to brush him and I started putting an oil in his food today from a local parapharmacy - Virbac Magaderm with essential fatty acids. Figured that can hurt while we continue analysis and treatments. The increased shedding was just another unusual sign that we noticed in the last month.

Dr. John :

My guess is that once his thyroid is properly managed and the underlying cause of why he is drinking more water, peeing more, etc is addressed, his appetite will return to normal and you won't have to worry about that

Dr. John :

As far as the hair - since it is just generalized increase loss, this is usually from the entire body being stressed

Dr. John :

My guess is that underlying cause I keep mentioning that is making him not want to eat as much, drink more, pee more, etc is the cause

Customer:

OK. This has been a big help. We'll continue trying to encourage prescription diet as long as he will eat it, while we keep the other cat at bay,

Dr. John :

Addressing that problem (if addressable) will also resolve the shedding

Dr. John :

Glad this has been helpful!

Dr. John :

Do you have any further questions?

Customer:

I am going to do some research on local internists - is there a worldwide directory or site you'd recommend for finding such ver=terinary professional.

Dr. John :

Yes there is -

Dr. John :

Also see if your current vet has any recommendations - perhaps someone he/she typically uses or deals with

Customer:

We will continue to use no doubt our local vets but multiple opinions and supplementary advice is useful. Thanks very much. Last questions... where are you actually located? And, if we wish to consult from time to time would it be with you or with a range of on-call vets via "JustAnswer?" This is my first time using it.

Dr. John :

I'm located in Florida... If you just post a new question, it will be whatever veterinarian online gets to it first. If you want to specifically request me, you can do so at this link

Customer:

OK - Will email local vet as well. Many thanks.

Dr. John :

If I'm not available (I work emergency shifts, so have limited availability) then I think someone else will get to you if I haven't answered back by a certain amount of time

Dr. John :

Hope that helps, you are very welcome, good luck with Saber!!

Dr. John :

 

Customer:

Perfect, thanks. Much appreciated. I'll get to work on increased exams/care for Saber. best regards, Barbara

Customer:

OK - I will cut and paste this into a file. Thanks again,. Dr. John.

Dr. John :

Good luck, keep me posted!

Dr. John :

You are very welcome

Dr. John :

 

Dr. John, Small animal veterinarian, ER vet
Category: Cat Veterinary
Satisfied Customers: 1205
Experience: significant surgical and medicine background, currently working as emergency clinic veterinarian
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