536. Text-message from a FLUTD cat owner

Yesterday, August 10, 2011, I met the FLUTD cat owner, a knowledgeable lady in her 30s. She had texted the following message to me the day before.

August 9, 2011 6.02 pm
Hi Dr Sing

TOMMY'S NOT PEEING AGAIN?!

It's been a few months since I updated you about Tommy. He was doing fine up till 2 days ago. Straining to pee and now vomiting after straining. Some fur in his vomit too. Very limtied appetite too, as if he's scared to eat lest he throws it up. I'll bring him to the clinic tomorrow morning. Hope you can see him and advise what's troubling him.

Happy National Day!

Names of husband and wife


I called her a knowledgeable lady as she had read all about FLUTD from the internet. She requested blood and urine tests, not just an injection and some antibiotics to go home. As vets, I would like to do the tests but some owners don't want to spend the money and so I try to give the basic treatment first and "wait-and-see" just to save the owner some money. This may not be a good way to practise veterinary medicine but Singapore owners go for the cheapest vet in town. All these tests add up to the costs and make me an "expensive" vet. However, to sophisticated and knowledgeable owners, failure to do tests indicate a vet not up to the mark! So, there must be a balance somewhere.

HISTORY-TAKING
"My cat can pee today!" the lady said.
"If your cat can pee," I replied. "There is no need to treat him."
Yet, on closer history-taking, the cat had difficulties peeing during the past 5 days, not 2 days.
"How do you know that your cat can pee normally?" I asked the lady.
"Well, he does it in front of me. He urinates a full stream of urine every morning in my presence."
An exhibitionist? I dared not say this loudly. Instead I asked when was the last time the cat could urinate without difficulty, namely a full stream of urine. It was 5 days ago, not 2 days as in her text message.

EXAMINATION
The significant finding was a painful abdomen and a weight loss of 1 kg compared to 2 months ago when I saw the cat (case report written, will get the URL). I could not palpate the left kidney. So, it would not be enlarged. His bladder was slightly full and contained some urine.

This is a 7-year-old male neutered cat that had FLUTD (feline lower urinary tract disease) some 2 months ago and had been on feline S/D diet for the past 2 months.

"Nobody tells me when I should stop the S/D diet. So two weeks ago, I had run out of S/D canned food and offered him ... (a commercial canned food).

"It is hard to say when the S/D canned food ought to be stopped. 2 months should be OK in some cases." I said. S/D is more expensive. This cat has been eating dry cat food over his past 7 years and just dislike canned food.

"Well, he has no choice, but to eat the S/D," the owner said when I asked her. The cat was losing weight.

"Could she be suffering from thyroid disease?" the owner asked me. This showed she had done her research in the internet. It is possible but the presenting sign is that of the urinary tract. So, I have to focus to check whether the cat has kidney disease or not first.

BLOOD TEST AND URINE TEST under sedation. I gave this 5kg cat xylazine 0.1 ml + ketamine 0.4 ml IM. With a few seconds whiff of isoflurane gas, he could be asleep with eyes open. The blood was collected from the big leg vein and his urine was collected from catherisation. About 20 ml of dark coloured thick urine. Claws were trimmed. No mouth ulcers or gingivitis. Pink tongue and mucous membranes. Some tartar on the teeth was scaled off.

After sedation injection, the cat vomited grass and dark yellow fluid (water and cat food likely, maybe some soil?). So the cat was not confined to inside the house as I presumed as he was supposed to me. He had access to the garden! To pee and be stressed out by neighbouring strays. This cat had lived in an apartment for the past 7 years till the shift to the parents' house temporarily. The cat had never seen other territorial cats before and now in this house, he met many. No wonder he was stressed out. He might be urine-marking too.

I will update readers soon as the case is being investigated. Like a detective story. Blood test and urine test results from the Lab will be in today.