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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 27336
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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Michael Salkin Only - FLUTD Kitty

Customer Question

For Dr. Michael Salkin only please!

Hi again Dr. Salkin! I just got back from an extremely long couple of days of hectic work and my better half brought to my attention that one of our intact males appears to have blood in his urine. I went to watch him for a bit and he seems to be urinating frequently and it is indeed blood tinged. He's also seems in pain, though is still eating and drinking, no fever is seen at present, and he's bright and alert.

It's been awhile since I've had any FLUTD issues and was wondering if you think it would be more likely crystals or an infection (or both)? I'm taking him to my clinic in the morning, but wanted your thoughts on what diagnostics would be best. I'm assuming fluids, antibiotics and a special diet would be our course of action? Would urinalysis change our direction? Or should I opt for an x-ray?

Let me know your thoughts when you can!

Thanks in advance!

Submitted: 1 year ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking with Dr. Michael Salkin
The urine of these males is usually sterile. Feline idiopathic cystitis is best treated by catheterizing the urethra if necessary and then diluting the urine with copious amounts of fluids given IV or SQ. Pain relief is administered and urine is obtained for urinalysis and perhaps bacterial culture and sensitivity. I don't usually treat with antibiotics if I see no evidence of infection and I haven't needed to catheterize my patient. I don't prescribe a special diet unless my patient relapses; instead, I feed wet food only which dilutes the urine and thus dilutes noxious substances in it and makes it less likely for gritty mucus to form and potentially obstruct my patient's urethra causing the classic "blocked cat". Please note that a change in diet can be a stressor and stress is considered a factor in the origin of this disorder.
Please give me an update on Pietro. I'm sorry if you've been waiting long. Your question was posted when I was in beddy bye.
Customer: replied 1 year ago.

Hi Dr. Salkin,

No worries about the delay in reply. I wanted to get the message posted so I caught you whenever you were next online.

My appointment for Pietro is not for another hour. I went to check on him in the morning and I do not see more evidence bloody urine. There are a couple of normal urinations in the litter box, but he's being secluded with his best friend to minimize stress so I'm not sure who the samples belong to. No one's home for me to check his nether regions, but when I checked last night I thought I saw a bit of mucous coming from his penis. He's still acting normal otherwise.

Would it be ideal then to get a sample for urinalysis? And then from there I would administer fluids and anti-inflammatories at home until we get the results? This boy isn't interested in wet food at all, but would it be safe to try experimenting with different brands today to see if I can change his mind? His diet has been the same for most of his life.

I feel a little more frantic about this situation because earlier in the year his younger brother suddenly passed away from a blockage. I remember reading somewhere that occasionally there's a genetic component. I'm hoping this is an isolated incident!

Thanks again!

Expert:  Dr. Michael Salkin replied 1 year ago.
He doesn't sound as if he's in trouble. Thank goodness.
No, let the vet obtain urine by cystocentesis - the most sterile manner in which to do that. Yes, you can give 150 ml LR daily for a few days. Which antiinflammatory do you have at home? Sure, see if you can interest him in a wet food. We haven't identified a genetic basis for idiopathic cystitis. We still don't know why it occurs.
It's always a pleasure speaking with you.
Customer: replied 1 year ago.

I have those silly plastic litter pellets for urine collection, but I did mean my vet would collect the sample through cystocentesis. Can this be done at any time or do I need to plan around him having some source of fluids in advance?

For Pietro, would fluids be ideal split up into two sessions?

I believe I'm out of any good anti-imflammatories for cats here. I could request one at the clinic today. What would be the one of choice - Feline Metacam?

Expert:  Dr. Michael Salkin replied 1 year ago.
I'd prefer that you didn't use the pellets unless absolutely necessary. No, fluids aren't necessary but removing his litterbox for at least 4 hours prior to his arrival at the vet hospital might ensure a bladder with enough urine to poke. Whether you dose him once or twice daily with fluids isn't critical. 150 ml over a 24 hour period should suffice. Yes, oral Metacam or an injection of robenacoxib which lasts 3 days.
Customer: replied 1 year ago.

Hmmm... Well he's just about to ho to his appointment. We may have to plan for the urine collection for tonight or tomorrow morning then? I'll let you know how everything goes.

Thanks again!

Expert:  Dr. Michael Salkin replied 1 year ago.

I'll watch your next post. Give Pietro a kiss for me.

Customer: replied 1 year ago.

Hi Dr. Salkin!

We managed to get a good sample of urine off to the lab and already have the results. I've posted them here:

I was instructed to start Clavasetin 50mg BID for 10 days, LR at least 100cc daily, and Cerenia for 5 days (4mg PO, or 0.5cc SQ). After the 5 days I'm supposed to stop the Cerenia for 2 days, then give it every other day for another week. The clinic was hesitant to give me a regular anti-inflammatory and told me that Cerenia would work in it's place. I've never used Cerenia as an anti-inflammatory before so wanted to know your thoughts on this? Also, aren't antibiotics given for a longer duration for UTIs?

I also wanted to know your thoughts on diet from here. We originally agreed to try to have Pietro on a more wet diet (which I'm still working on). Is that still the direction I'm heading? The clinic of course recommended a veterinary diet. Considering he eventually needs to live with other cats (most of which are queens intending to get bred or are already pregnant) I don't feel comfortable having him on something like Urinary S/O. Firstly it would definitely cost an arm and a leg to feed everyone that here, but secondly (and more importantly) I don't think the quality of this food is ideal for everyone here. If I could have Pietro eating mostly canned or a commercial raw, that would best. Likely I'd have to have him by himself during meal times to make sure he's actually getting his fair share, but that's much easier to manage. What do you think?

(P.S: Pietro appreciates the kitty love!)

Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you! It certainly looks like the more unusual bacterial UTI rather than idiopathic cystitis. Further investigation has found that maropitant (Cerenia) also has antiinflammatory properties and so it's being prescribed for cystitis. I don't have any experience in that regard. Treating a UTI in cats for as little as 7 days has been effective. Just be sure to have the urine rechecked 2 days after the course of antibiotics is done.
He doesn't need a prescription diet for a UTI. This apparently isn't the idiopathic cystitis we more commonly see which might be addressed with such a diet. In fact, because this isn't idiopathic cystitis, even restricting him to wet food isn't essential but would be helpful for the next week or so.
Customer: replied 1 year ago.

The diet was recommended because struvite crystals was found in the urine sample. Do you think that those will get better as the UTI is treated? I wasn't sure if one begot the other.

Thank you for confirming for me that Cerenia's anti-inflammatory properties. Do you feel that's enough to keep Pietro comfortable? I was offered a pain killer if he's uncomfortable, the clinic just didn't feel comfortable with a steroidal anti-inflammatory.

Pietro rejected the canned turkey we have here but ate about half of the commercial raw turkey and fish. Hopefully these are small steps in the right direction. He took his LR/SQ easily.

Expert:  Dr. Michael Salkin replied 1 year ago.
Struvite crystals are found in normal urine. This is a common error in judgment. The finding of struvites is more important in the cat suffering from idiopathic cystitis and forming the gritty struvite-containing mucoid plugs which then can obstruct the urethra or in cats forming actual stones composed of struvites.
Kinnee, studies of maropitant as an antiinflammatory analgesic in the urinary tract are lacking. We'll have to watch Pietro to see if he remains uncomfortable while being administered the Cerenia. I don't understand the reticence administering the injectable robenacoxib - a nonsteroidal antiinflammatory drug. A steroid would be contraindicated in the face of infection, however.
Raw turkey and fish...yum! Yes, fluids is sure wonderful stuff or "the bomb" as my daughter might say.
Customer: replied 1 year ago.

Hi Dr Salkin!

I thought I'd let you know that Pietro is doing very well. At least from what I can see in his litter box, his urine is looking much better. He actually showed drastic improvement from just a couple of days on the Clavaseptin!

He hasn't finished his round of antibiotics yet, but I'm wondering if it's safe to stop his SQ fluids? Or should I continue them until we have a confirmed clear test? He's behaving well while I administer it, but is obviously not impressed by the entire situation. I can only get him to eat a little bit of his wet food each night now which is frustrating! I'm not sure how to get this bugger to eat anything consistently that isn't kibble.

Thanks again!

Expert:  Dr. Michael Salkin replied 1 year ago.
Yay! You've administered more than enough fluids. You can lead a cat to wet food but you can't get him to eat it...
Thank you for the good update!
You're welcome, again.
Customer: replied 1 year ago.

I'm sure he will be happy about that!

After he's finished his antibiotics would the next step be retesting after a couple of days? Then if the infection is clear is there anything I should be doing to ensure it doesn't return? Is it safe to assume this will likely be an isolated incident?

Expert:  Dr. Michael Salkin replied 1 year ago.
The standard of care is to wait 2 days after the course of antibiotics is completed and then either recheck a urinalysis or repeat a bacterial culture and sensitivity. If the infection is gone, you expect it to have been an isolated event and don't need to do anything special for Pietro except give him a kiss on his head once in a while.