Severe Cystitis, Meloxoral and Clavaseptin, w/o urinary testing???

[Stefania S]

Hi all,

Jessi came down with a severe case of what seems to be a UTI/bladder infection post Ct scan on Monday. She has been urinating all over the place in some moments, other times, she pees more normally. Appetite is inconsistent and significantly diminished, and she is even weaker than before the Ct.

She has never had a UTI or bladder infection or anything else like this before. It is completely unprecedented. Just a couple of weeks ago she had a urinary test and it was clean.

Vet prescribed CystoCure, but I notice it has a bunch of sugars in it: Maltodextrin, Glucosamine, Brewer's Yeast, Cranberry Pulp, Sodium pyrophosphate, Lupin protein meal (don't ask why), Palm oil, Products and By products from processing fresh fruits and vegetables (I think this is something fermented), Whey protein, sunflower oil.

[I searched for a link to a page with the accurate ingredients and I couldn't so I just typed them out.]

I tried giving her a little straight up cranberry powder in her food but she refused it. I have to be careful not to do anything that will make her stop eating altogether. I am hoping this Cystocure has a flavor that will entice her to eat and get her to take the supplement at the same time.

Sometimes her appetite returns, but then it goes again. We haven't had appetite issues like this for months, not since I started giving insulin in April. I am at my wits end.

I'm about to break out a higher carb food just to get her to eat....

Can you tell me if the ingredients in CystoCure are something to be avoided, or if I can go ahead and give it to her to see if it helps clear this Bladder thing?

I hope it's just a simple UTI. I don't exactly understand how it could suddenly come on after a Ct scan. I thought the contrast solution might be to blame, the Vet says the stress itself, and/or the anesthesia.

I will try it out if no one tells me this is too sugary or anything else. I have to try something. We postponed surgery for her SCC tumor (AGAIN) because she was too weak and in distress from this. I need to get her back to at least a moderate state and eating well, before she can have the surgery which she really needs to have. I am willing to try anything as long as it won't make things worse.

Btw, we have been off monitoring for weeks because of the complex heath saga that has been unfolding and Jessi's high stress inducing resistance to BG testing. Please don't ask me to provide this information right now, I just can't. I hope you will help me answer this one question so we can take the next step to getting her strong enough to have surgery.

Oh, and her ketones are zero.

Thanks for your input and support!

 

[Sienne and Gabby (GA)]

Maltodextrin has a high glycemic index. I would let your vet know it's not a great choice for a diabetic and see if there's an alternative.

 

[Chris & China (GA)]

You might try making a Liver Shake and see if she'll eat that. It takes a little work and finding raw beef or chicken liver can sometimes be a challenge.

On the UTI....how was it diagnosed? Without doing a cystocentesis and sending it off for a Culture and Sensitivity, there may not be a UTI in the first place. If bacteria are found in a urine sample (can be found by a drop of urine on a slide and looked at through a microscope), then it's important to have them run the C&S to find out exactly which bacteria you're dealing with and which antibiotic is most effective at killing it. While waiting for the results, they can go ahead and start with any broad-spectrum antibiotic and then when the culture results come back, if that drug isn't the most effective, you can change then.

Sterile cystitis is much more common than a legitimate urinary tract infection and stress is the #1 cause.

Lots of great information for you to read (written by a vet with a special interest in feline nutrition) HERE

Best of luck to you and hope she feels better soon and her appetite returns!

 

[Stefania S]

You might try making a Liver Shake and see if she'll eat that. It takes a little work and finding raw beef or chicken liver can sometimes be a challenge.

On the UTI....how was it diagnosed? Without doing a cystocentesis and sending it off for a Culture and Sensitivity, there may not be a UTI in the first place. If bacteria are found in a urine sample (can be found by a drop of urine on a slide and looked at through a microscope), then it's important to have them run the C&S to find out exactly which bacteria you're dealing with and which antibiotic is most effective at killing it. While waiting for the results, they can go ahead and start with any broad-spectrum antibiotic and then when the culture results come back, if that drug isn't the most effective, you can change then.

Sterile cystitis is much more common than a legitimate urinary tract infection and stress is the #1 cause.

Lots of great information for you to read (written by a vet with a special interest in feline nutrition) HERE

Best of luck to you and hope she feels better soon and her appetite returns!

Thanks Chris, unfortunately raw liver gives Jessi diarrhea every time, at which point she stops eating altogether. Cooked liver is better but even with that it has to be balanced with other foods. Right now she is having a 'bout' where she strains, pees many many times, pees all over the place, and little bits of blood clots and mucosa come out...when this happens she stops eating and drinking. when it subsides she first drinks a lot and eventually eats. Overall, she is eating at least half as much as usual, maybe less.

Actually, chicken and beef liver are easy to come by here, but I never get it because she doesn't seem to digest it well. If it's a little bit mixed in with a meal with muscle meat and other ingredients, it's ok, but not raw and not alone. She has quite a few intolerances and chronic digestive issues.

Cystitis is the word the vet used, I just don't know exactly what that means. Inflammation of the bladder? If it isn't an infection then would antibiotics still be the treatment? other than stress, couldn't the contrast solution used for the Ct scan be a factor? it can be quite harsh as far as I'm aware. And then there is the anesthesia itself...

Tomorrow I will have to take her to the clinic to have this assessed, which means more stress and more postponing SCC tumor removal surgery...it's a long story, I have other threads about it. It has been months of the surgery getting postponed for one reason or another.

Is a clean catch an adequate way to get a urine sample or does it really have to be a cystocentesis? These are rather invasive and they have done so many of these on her in the last months, I would rather avoid another if I could.

I don't have a lot of time or energy to devote to doing research right now, the situation is too pressing and all consuming, but thanks for the share. I'll take a look later when things settle down.

 

[Sienne and Gabby (GA)]

There's a good section that's worth reading on Dr. Lisa's feline nutrition site about urinary tract issues.

 

[Stefania S]

There's a good section that's worth reading on Dr. Lisa's feline nutrition site about urinary tract issues.

[I started writing the reply below days ago and never finished. Too much going on here! I am taking her to the clinic tomorrow morning because it hasn't cleared and she is obviously in pain and even more weakened than before from this. It's a vicious cycle we're caught in now, I hope we can break out of it soon...]

THanks for the article, I did read it and it was definitely helpful. I feel pretty sure this is not a UTI (as in 'infection') but an inflammation brought on by acute stress. Also, over the last months, Jessi has had many stressful events, many visits to Vets, procedures, etc., and many moments in which she was holding her pee for hours because the Vets kept her for so long without giving her a place to pee. Reading another article, I was reminded that holding your pee can cause urinary issues.

Then, of course, there are the obvious factors that Diabetic cats have, and add to that the harsh contrast solution and the stress of anesthesia and it was probably a tipping point for Jessi's urinary system.

She improved a lot over the last 24 hours, so much so, I thought it had cleared, but today she had another bout. Still, her appetite is much better since yesterday and she is bouncing back faster from when she has a bout. I'm calling it that, what I mean is she starts urinating very frequent tiny amounts, then she starts straining to pee, then she starts peeing outside the box, and then lying down to pee...until it clears after usually two to three hours when she goes back to peeing more normally, drinking and eating again. it is definitely much better since it started last Monday. [Now this is happening only once a day, usually in the evening, so there is definitely some improvement, but not enough.]

It is very concerning to see big blood clots and bloody mucous in the pee. Today she passed a really long, thick wormy looking one, the biggest one I've seen ever. Not to alarm anyone, but it is a bit alarming to see. I understand this can be a normal part of an idiopathic cystitis, but not fun to watch and definitely painful for her.

She usually drinks lots of water, unless she is conked out from exhaustion. I only feed wet food, except for the freeze dried treats I use as rewards, enticement, etc...so as far as hydration is concerned, we're in good shape. Stress, is another matter entirely....



I hope they will have something concrete to help with this. She needs to have her SCC tumor surgery and this Cystitis is in the way.

Wish us the best! I will keep you posted!

Thanks again for your support!

 

[Diane Tyler's Mom GA]

Your poor kitty, breaks my heart , I hope they can figure out what's going on.
Yes please keep us updated

 

[Stefania S]

Hi all, so we went to the Vets today, saw a general internist this time, rather than the oncologist. Unfortunately, Jessi was peeing in the carrier before we even took her out (that's how hard it is for her to keep it in right now, plus the stress triggered the bladder to expel) and by that time there wasn't enough left in her bladder to do either a urinalysis or Cystocentesis. The Vet was able to see the mucous coming out on the spot. They did an ultrasound of the abdomen and some bloodwork. Kidneys are not only fine, the creatinine improved since the last test a few weeks ago! Yey for good news! Bladder wasn't full enough to see clearly, but they think it looked thickened (inflamed?). they also some some indication of the uterus being affected which she interprets as a bad infection.

She says Jessi's case is quite severe and requires immediate therapy, especially given the complexity of her situation, Diabetes, SCC tumor (pending surgery), gut issues...and over all weakened state. She is very skinny and weak from this bladder thing, aside from the pain she experiences each time solid stuff passes through the urethra, which is about once a day for several hours.

Without either urinary test the Vet is prescribing Clavaseptin (which we have used twice before for Sacculitis successfully), and Meloxoral for pain and inflammation just for 2 days, 3 at the most.

Normally, I would take time to weigh the options, but there isn't much time and I have to be very careful not to piss these Vets off a second time (long story). I told the Vet I could take Jessi to a clinic much closer to home in the hopes of getting a cystocentesis done, but she thinks I shouldn't stress her anymore and wants to proceed with this therapy.

I know it's not good to prescribe antibiotics without knowing that it's an infection, but I'm not sure I can wait and investigate further.

Tell me your thoughts.

I did wait about a week and a half before taking her to the vet to see if it would clear on its own, and even though it seemed like there were some improvements, she is still very ill with this.

 

[Stefania S]

Is it safe to give Meloxoral? I am supposed to start immediately.

 

[Diane Tyler's Mom GA]

Sending prayers for Jessi,

 

[Stefania S]

Meloxoral (meloxicam) is a strong analgesic in the FANS category, from what I know. Jessi has chronic digestive issues. I’m concerned about the possible side effects of for her gut.

Waiting on your feedback before giving it to her...

Also I have never syringe force fed anything to Jessi and she is so easily stressed to high degrees.

Any suggestions there?

Thank you

 

[Sienne and Gabby (GA)]

There are on-going debates here about the use of meloxicam. In the US, the dosing is higher than in other countries. Any NSAID -- it's a nonsteroidal anti-inflammatory drug (which is what it's called in the US) -- can have an impact on the kidneys. Some cats have an adverse response and go into kidney failure.. In the US, the FDA has a black box warning on the use of meloxicam in cats. In other countries, the dosing is more conservative and it has been used successfully.

I would want to make sure she gets some food into her. It's best to not give the pain meds on an empty stomach. Try finger feeding or spoon feeding her before going to a syringe if you think that would be stressful.

I think you have to weigh the options regarding having a cystocentesis done vs empirically prescribing an antibiotic. Just as an example, I can't think of a time when I've had an MD run a blood culture to diagnose a problem. They've just prescribed an antibiotic. If I didn't respond, they tried something else. The only time I've seen cultures run is with patients who are in the hospital and there is a very good reason for running a culture but even in those situations, the patient is put on broad spectrum antibiotics to prevent things from going from bad to worse. (A culture can take 5 days to see results.) If taking Jessi to your local vet is only going to stress her out more, I'd see how she responds to the antibiotic the vet prescribed.

Also, glucosamine is fine. It is one of the compounds that's often used for inflammation when people have arthritis. It can also be helpful with idiopathic cystitis. It's usually sold in a combination with chondroitin for joint related issues.

 

[Stefania S]

There are on-going debates here about the use of meloxicam. In the US, the dosing is higher than in other countries. Any NSAID -- it's a nonsteroidal anti-inflammatory drug (which is what it's called in the US) -- can have an impact on the kidneys. Some cats have an adverse response and go into kidney failure.. In the US, the FDA has a black box warning on the use of meloxicam in cats. In other countries, the dosing is more conservative and it has been used successfully.

I would want to make sure she gets some food into her. It's best to not give the pain meds on an empty stomach. Try finger feeding or spoon feeding her before going to a syringe if you think that would be stressful.

I think you have to weigh the options regarding having a cystocentesis done vs empirically prescribing an antibiotic. Just as an example, I can't think of a time when I've had an MD run a blood culture to diagnose a problem. They've just prescribed an antibiotic. If I didn't respond, they tried something else. The only time I've seen cultures run is with patients who are in the hospital and there is a very good reason for running a culture but even in those situations, the patient is put on broad spectrum antibiotics to prevent things from going from bad to worse. (A culture can take 5 days to see results.) If taking Jessi to your local vet is only going to stress her out more, I'd see how she responds to the antibiotic the vet prescribed.

Also, glucosamine is fine. It is one of the compounds that's often used for inflammation when people have arthritis. It can also be helpful with idiopathic cystitis. It's usually sold in a combination with chondroitin for joint related issues.

Thanks for the feedback. I did give the Meloxoral to her Saturday on a full stomach. The syringe has dosing marks according to body weight, and the Vet prescribed the amount for 3kg (she's pretty skinny still), which is 0.3ml. Oddly, I had no trouble giving it to her, held her in my lap facing away from me, which she doesn't like, scruffed her a little, and put the syringe in the side of her mouth. She took it fine. I was kind of impressed I could do that, but then I realized it's probably because she doesn't have much energy to struggle right now.

A few hours later, I noticed she was sneezing a bit too often, but I thought it was because something got in her nose, which does happen sometimes. There seemed to be some positive effects, she was moving around more, looking like she wasn't in as much pain and many hours had passed, at least 24, since the last urinating bout (although that was happening even before I gave her the AI) until 1am Saturday, when I was almost ready to go to bed when she started peeing perpetually again. So we stayed up a couple of hours until she passed some more bloody clumps and her urine returned to more normal and she ate again.

Sunday, her nose and eyes were very runny, so much so that I started thinking this was a reaction to the Meloxoral. So I called the clinic ER, since the main clinic was closed. I described to her the sudden onset of symptoms and she recommended skipping the second dose. I was only supposed to give 2 doses total. I was relieved the Vet gave me the out I wanted. I didn't feel comfortable giving another dose with those symptoms. There is no way to know for sure if they were brought on by the med but in the doubt, it felt better to skip.


We started Clavaseptin Saturday evening which seems to be having very quick positive effects. Cystitis symptoms are clearly improving. Down side is now she has this runny nose and eyes, but I'm staying optimistic that this will clear quickly.

Fingers crossed we will be able to have the SCC surgery soooooooon! She needs to be freed of that disturbance, and so do I!

Please keep sending your good vibes, wishes, prayers...whatever works, we'll take it!

Thank you!!!