Hello, my name is***** and I have over 20 years of experience as a veterinarian. I am sorry to hear that Connor is having difficulty with blood in his urine, vomiting and urinating small amounts, and a loss of appetite.
I understand that he has a previous history of crystals in his urine which led to him needing to be catheterized. Did he actually have reconstructive surgery called perineal urethrostomy? This surgery creates a new opening i the urethra higher up near the brim of the pelvis where the urethra is wider in the hopes that the kitty won't become blocked again. Or did he not have that surgery but rather catheterization and repeated flushing to remove excess mucous and debris? We generally start with that.
Was his diet changed after his initial episode?
It appears that he's had some of testing done, with fairly normal results other than increased blood in his urine.
Ultrasound would allow evaluation of the architecture of his kidneys and bladder wall, and some calculi are not visible on normal radiographs but can be seen on ultrasound. If you can afford it I think an ultrasound would be a great idea if he continues to have trouble.
He is on medication to decrease chances of a secondary infection from being catheterized (Baytril) and an antispasmotic to open his urethra and allow him to urinate more comfortably. But he may still be in pain, and I suspect he is because he is continuing to try to lick. Cats that are painful often don't eat well. Perhaps adding a pain medication like Buprenex (buprenorphine) would be beneficial.
If he truly doesn't have any bladder or kidney calculi then I suspect that he may have a condition called interstitial cystitis. Interstitial cystitis is an inflammation of the bladder wall that we think is worsened by stress. The primary condition we are having trouble pinning down.
We do know in these cats however that the mucous layer that protects the bladder wall from urine (which is a mucous membrane irritant) seems to be faulty. So glucosaminoglycans (like adequan) are postulated to help as they are a building block for this mucous. It isn't something that the drug companies can advertise or label the drug for as they would need to do extended testing and trials and there simply aren't enough cats affected to make this worthwhile for them. This is something we do for these cats as we have some anecdotal evidence (reports from other veterinarians that have tried it) that it works. You can give him oral glucosamine supplements like Cosequin to try to prevent further episodes.
Omega 3 fatty acids are natural anti-inflammatories that are important for healing and mucous membrane and skin health. I recommend an omega 3 fatty acid dose based upon the EPA portion (eicosapentanoic acid) of the supplement as if we do that the rest of the supplement will be properly balanced. Give him 20mg of EPA per pound of body weight per day. For example an 8 pound kitty could take 160mg of EPA per day.
Omega 3's and glucosamine/chondroitins can work synergistically and improve bladder wall health as well as reducing inflammation. They can take several weeks to see full improvement but some cats do very well with them alone. They are available over the counter.
Likewise we know that by decreasing stress these cats do better and have less episodes in the long run.
Encouraging play behavior and exercise is a natural way to relieve stress. Fishing line toys for him to chase, hiding treats for him to "hunt down" in cat trees or kitty condos can be fun for him too. Perhaps building an outdoor enclosure on a patio or porch so he can go out safely would help.
I recommend Feliway too as a stress reliever, especially if we believe that there are other pets in the home or outdoor animals that are causing her stress. This is a synthetic analog of a calming pheromone that cats use to mark things as safe or home. You can also continue using Rescue Remedy drops along with Feliway.
Zylkene is another supplement that may help relieve her stress and thus decrease his symptoms. Here is a link if you's like to read more about it: http://vetoquinolusa.com/Products/Behavior/index.html
Amitriptyline or fluoxetine are prescription medications that are very good at relieving anxiety in some cats, so we can use one of these medications well if supplements aren't enough.
Increasing water consumption helps by diluting the urine, thus decreasing its irritant effects. You should feed him primarily canned food, and add chicken broth or warm water to increase fluid intake further. Kitty drinking fountains can be very beneficial to get him to drink more. He may play in the water, so I recommend putting it on a water proof matt. I know this is messy but play relieves stress too, so I would let him play in it.
I can tell you I have one patient that did very well for a number of years on amitriptyline, glucosamine/chondroitins and omega 3 fatty acids. The owners reported that she was a new cat on this regimen.
Your veterinarian is doing the right things by testing to make sure there isn't an infection or hidden calculi or a mass behind his symptoms. Those things should be ruled out first. Treating with antibiotics and an antispasmotic after catherization is appropriate too, but I would add a pain reliever too.
In some cases we are left with a stress driven illness and then long term we must do our best to change things and relieve stress.
Please let me know if you have any further questions.