Tuesday, June 2, 2015

2179. Another 5-year-old male neutered black and white cat has dysuria

Jun 2, 2015

Within 7 days, another black and white cat came in with dysuria, haematuria and pollikiuria. He is 5 years old, neutered. This is the first occurrence of difficulty in peeing and peeing everywhere, away from the litter box.  The mother and two teenaged boy and girl came with the fat cat.


"Is there another cat in the apartment?" I asked.
"Yes," the mother said. "A female spayed cat. But they got along well together."
"Did she bully him?"
"Sometimes. She hisses at him.  We're are not at home the whole day and so would not know if there is any bullying"

"This can be quite stressful. This problem is most common in male neutered cats. It is called FLUTD (feline lower urinary tract disease). It looks like a case of FIC (feline interstitial cystitis), said to be due to non-infectious cause in 60-70% of the cases and said to recover on its own by one cat vet from Canada when she gave her lectures in Singapore.

IN THIS CAT
1. Urine collected by catherisation on Jun 2, 2015
Amber, clear
pH 7 (5-8),
USG 1.047 (1.005-1.030)
Protein +
Blood 2+
No bacteria
White blood cells 26. Red blood cells 56
Crystals  Triple phosphate occasional.



2. Blood test
Glucose high 6.9  (3.9-6)
Platelets low  238  (300-800)


Other values normal esp. no kidney disorder or leucocytosis, neutrophilia.


3. X-rays. No radio-dense stones in the bladder and kidneys.






This cat's bladder was irrigated with normal saline and sent home with meloxicam and so far so good. .Based on the tests of no bacterial infection in the urine, this cat is diagnosed as suffering from feline interstitial cystiis (FIC). Cause is probably struvite sand irritating the bladder and urethra as confirmed by urinalysis of triple phosphate crystals seen.

This cat lived with a male neutered cat with no problem.


For FIC, the literature says that 60-70% of cases are not due to bacteria and will recover on its own. But how does the owner or vet guarantee that the cat will recover on its own?  What if it progresses to kidney disease and prolonged pain and dysuria? Will the vet be sued or investigated for negligence?

THE OTHER CAT WITH RECURRENT FLUTD

The problem recurred for the 3rd time last week. The first onset was 2 months ago when another vet hospitalised the cat and did the blood and urine tests. The cat recovered and Royal Canin S/O was prescribed by the first vet. The cat did not eat it. Then 2 weeks ago, same problem. 

No abdominal X-rays for stones were done by me during the 2nd time when the cat could not peed 2 weeks ago. No urine, X-rays or blood test were performed to lower medical fees for the owner. There was no bladder and kidney pain nor inflamed genitals and so I did not advise such tests. I advised C/D canned food + dry. The owner was unsuccessful in converting the cat to eat 100% C/D canned food. 

However, in this 3rd recurrence after one week of consultation, I prescribed meloxicam and ACP 2.

5 mg bid by bringing the medication to the son on June 4, 2015 in Chinatown. The mother was unable to come with the cat and thought of euthanasia.  She remembered that there was a need to do the X-rays to eliminate bladder and kidney stones if there is a 3rd recurrence. But she needed to find time to come to the clinic.  It was extremely stressful to see her cat not being able to pee. This cat lived with a female spayed cat who hissed at him. 

Once FLUTD happens, there is a high chance of recurrence. 


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