Melissa and Rascal
Member Since 2015
Sorry for the long post, but there is a ton going on with this cat and kind of a mystery diagnosis situation I've got. I posted a few weeks ago on this (see link below). I have been treating for both infection and non-infectious cystitis and not much has changed at all.
If you don't have time to read the whole crazy history below, I'm basically asking if 1) a cat can indeed have a UTI even if a urine culture is negative, and 2) how likely is it given a negative culture that an 18-year-old diabetic cat would instead have a three-week-long flare up of non-infectious cystitis (just inflammatory) years after her last FLUTD episode? Details below...
http://www.felinediabetes.com/FDMB/...and-bladder-inflammation.152942/#post-1608266
So as I said, Rascal does have a history of FLUTD. She has never ever had a positive urine culture in her life. About three weeks ago she started having symptoms of UT problems - frequent trips to the litter box, voiding small amounts, licking her genitals a lot, etc. It was not as bad as the assumed cystitis flare ups she used to get when she was younger where there was blood in the urine and she was in even more distress. She still has to be uncomfortable now though too.
I took her in a couple weeks ago and they ran a urinalysis and culture and it came back negative. My understanding is a culture is definitive, right? The vet still put her on clavamox though just in case. She has been put on antibiotics in the past even when she probably did not have an infection - years ago when diagnosed with FLUTD and then zeniquin last summer for a few weeks when she wasn't even having symptoms but there were WBCs in her urine. We did not do a culture last summer, but the vet thought with her age and diabetes the risk of infection was high. We finished the antibiotics and that was that.
Years ago when she was diagnosed with FLUTD her episodes, while intense, would clear up in a few days to a week. Cystitis flare ups usually tend to ease up on their own in that time frame according to what I've read.
So this time after having symptoms but a negative culture again we made it through seven days of clavamox. It was bothering her stomach (she has IBD) so the vet said we could stop it. That was about a week ago.
We have now had about one week of symptoms before antibiotics, one week on antibiotics, and one week off now - and really nothing has changed throughout as far as UT symptoms are concerned. A lot of things don't add up here. I have no idea what this poor cat has!
If it is a UTI wouldn't it have shown up on the culture? The vet was concerned maybe an infection could still be present in the tissues without showing bacteria in the urine. If it's an infection, why did the seven days of antibiotics not do anything? Unless it was the wrong drug (but you can't do sensitivity when nothing grows on culture). I would also think it would be getting worse now again off of antibiotics for a while.
If it is FLUTD/non-infectious cystitis why is the flare up lasting this long? It never has before, and this is longer than the typical duration of an episode. I have read some cats have a more chronic presentation though. Also, why would it be flaring up at her age after no more problems for several years? I've read many cats stop having episodes as often with FLUTD as they get older. So this doesn't totally fit either!
Whatever it is, the vet has noted that her bladder wall has appeared thickened and inflamed on ultrasound the last several months. This has not changed much and is uniform in appearance so cancer is unlikely. Also the fact that she has discomfort in the genital area points to possible urethritis consistent with either infection or sterile cystitis.
With Rascal's IBD, diabetes and now this, it has been very difficult to figure out what is going on. But for the last three weeks all I can say in summing up is there have been the UT symptoms, decreased appetite, pain and/or nausea that is new, increased weakness and lethargy, increased back leg weakness especially with more of a plantigrade stance, and behavioral changes like walking into another room and howling like she's scared or confused. She's done the howling some in the past but never this much. She is 18 so there could be cognitive issues going on as well, or some of this could be medication side effects too.
She is on a slew of medications - budesonide, mirtazapine, and cerenia and buprenorphine as needed. I've given her a little prednisolone here and there lately. I started her on a low dose of pepcid. I am encouraging lots of drinking, playing with her as much as she has the energy for, using feliway pheromones, trying to decrease her stress even though there really hasn't been anything new going on. I am still giving d-mannose and Sovereign Silver when I think of it in case there is an infection. She drinks both readily on her own, and I have started a Bladder Support product from Dr. Mercola as well.
I'm at my wits' end trying to figure out what is the problem here. Is it an infection or inflammatory non-infectious cystitis?
I guess I will just keep doing what I'm doing and maybe see the vet again next week, but this is altering her food intake, her BGs and insulin needs and everything else. It is also causing me to wonder if there is something more serious going on.
If anyone has any ideas as to what this might be, I would be ecstatically grateful!!! And if you've made it this far, thank you for caring enough to read all this.
If you don't have time to read the whole crazy history below, I'm basically asking if 1) a cat can indeed have a UTI even if a urine culture is negative, and 2) how likely is it given a negative culture that an 18-year-old diabetic cat would instead have a three-week-long flare up of non-infectious cystitis (just inflammatory) years after her last FLUTD episode? Details below...
http://www.felinediabetes.com/FDMB/...and-bladder-inflammation.152942/#post-1608266
So as I said, Rascal does have a history of FLUTD. She has never ever had a positive urine culture in her life. About three weeks ago she started having symptoms of UT problems - frequent trips to the litter box, voiding small amounts, licking her genitals a lot, etc. It was not as bad as the assumed cystitis flare ups she used to get when she was younger where there was blood in the urine and she was in even more distress. She still has to be uncomfortable now though too.
I took her in a couple weeks ago and they ran a urinalysis and culture and it came back negative. My understanding is a culture is definitive, right? The vet still put her on clavamox though just in case. She has been put on antibiotics in the past even when she probably did not have an infection - years ago when diagnosed with FLUTD and then zeniquin last summer for a few weeks when she wasn't even having symptoms but there were WBCs in her urine. We did not do a culture last summer, but the vet thought with her age and diabetes the risk of infection was high. We finished the antibiotics and that was that.
Years ago when she was diagnosed with FLUTD her episodes, while intense, would clear up in a few days to a week. Cystitis flare ups usually tend to ease up on their own in that time frame according to what I've read.
So this time after having symptoms but a negative culture again we made it through seven days of clavamox. It was bothering her stomach (she has IBD) so the vet said we could stop it. That was about a week ago.
We have now had about one week of symptoms before antibiotics, one week on antibiotics, and one week off now - and really nothing has changed throughout as far as UT symptoms are concerned. A lot of things don't add up here. I have no idea what this poor cat has!
If it is a UTI wouldn't it have shown up on the culture? The vet was concerned maybe an infection could still be present in the tissues without showing bacteria in the urine. If it's an infection, why did the seven days of antibiotics not do anything? Unless it was the wrong drug (but you can't do sensitivity when nothing grows on culture). I would also think it would be getting worse now again off of antibiotics for a while.
If it is FLUTD/non-infectious cystitis why is the flare up lasting this long? It never has before, and this is longer than the typical duration of an episode. I have read some cats have a more chronic presentation though. Also, why would it be flaring up at her age after no more problems for several years? I've read many cats stop having episodes as often with FLUTD as they get older. So this doesn't totally fit either!
Whatever it is, the vet has noted that her bladder wall has appeared thickened and inflamed on ultrasound the last several months. This has not changed much and is uniform in appearance so cancer is unlikely. Also the fact that she has discomfort in the genital area points to possible urethritis consistent with either infection or sterile cystitis.
With Rascal's IBD, diabetes and now this, it has been very difficult to figure out what is going on. But for the last three weeks all I can say in summing up is there have been the UT symptoms, decreased appetite, pain and/or nausea that is new, increased weakness and lethargy, increased back leg weakness especially with more of a plantigrade stance, and behavioral changes like walking into another room and howling like she's scared or confused. She's done the howling some in the past but never this much. She is 18 so there could be cognitive issues going on as well, or some of this could be medication side effects too.
She is on a slew of medications - budesonide, mirtazapine, and cerenia and buprenorphine as needed. I've given her a little prednisolone here and there lately. I started her on a low dose of pepcid. I am encouraging lots of drinking, playing with her as much as she has the energy for, using feliway pheromones, trying to decrease her stress even though there really hasn't been anything new going on. I am still giving d-mannose and Sovereign Silver when I think of it in case there is an infection. She drinks both readily on her own, and I have started a Bladder Support product from Dr. Mercola as well.
I'm at my wits' end trying to figure out what is the problem here. Is it an infection or inflammatory non-infectious cystitis?
I guess I will just keep doing what I'm doing and maybe see the vet again next week, but this is altering her food intake, her BGs and insulin needs and everything else. It is also causing me to wonder if there is something more serious going on.
If anyone has any ideas as to what this might be, I would be ecstatically grateful!!! And if you've made it this far, thank you for caring enough to read all this.
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s for you.