Mister has blood in urine, again

Mister's symptom of "frequent unsuccessful attempts at litter box" is the very reason I brought him into the vet just prior to is diabetes diagnosis in early January 2022. On the day I brought him in, he was peeing blood and not able to pass any pee.

Several months later, today he is doing this same thing. He's attempted to pee many times today and is not able to. He is now trying to pee in random spots around the house. At some point this morning he was able to use the litter box and pee, as there was a small to medium size clump in the litter box.

There is blood on his urethra right now.

The vet opens at 7:30am tomorrow, what should I do? Ultrasound? When they did an x-ray last time this happened, they said they didn't see any stones, but according to the link below some stones are invisible to x-rays unless you use a special type of procedure and contrast.

https://vcahospitals.com/know-your-pet/cystitis-and-lower-urinary-tract-disease-in-cats (he has every single symptom that is listed in the bullet points in this link)
https://vcahospitals.com/know-your-pet/feline-idiopathic-cystitis
https://vcahospitals.com/know-your-pet/bladder-stones-in-cats

 

@Wendy&Neko
2 previous posts from today on the lantus forum
https://felinediabetes.com/FDMB/thr...-from-prozinc-to-levemir.263565/#post-2961880
https://felinediabetes.com/FDMB/thr...hat-are-my-options.262196/page-2#post-2961886

 

I just let him outside and he attempted several times to urinate, leaving behind trace amounts of urine and more blood than urine.

The blood has a membrane around it, I couldn't even poke through it with a BG test strip. It looks like an earthworm almost.

 

It could be a UTI or it could be FLUTD.
I think you need to ask for a C&S test on the urine to see if it is a UTI. If that comes back negative, it is most likely FLUTD.
Google it to read about it.
It is very common in cats. My Sheba had it. There are treatments to deal with flare up and ongoing treatments to try and prevent them.
Sheba had an ultrasound to eliminate everything else before the FLUTD diagnosis.
I would encourage him to drink plenty of water as long as he is still peeing small amounts. Blood in the urine is common with FLUTD.
If he stops peeing altogether and is still straining, I would take him to the vet immediately as he may be blocked.

 

Casper was diagnosed when his BG was in the 500's. First thing our Vet said was he has seen many a cat have a UTI when first diagnosed because of high uncontrolled BG while undiagnosed. Vet put him on a 10 day oral antibiotic though he could have had a shot of antibiotic but I elected the 10 day oral as it was more economical. When his UTI was controlled with antibiotic Casper's litterbox use (or lack thereof) changed back to normal.

 

He also has diarrhea today, which is unusual because usually it's the opposite and his poop is overly hard. This could be the cabergoline causing this.

I'm hoping my vet can get me in in the AM.

I googled a bit and I think what I described in my previous post regarding the blood having a membrane is called a "mucous plug".

 

Neko's buddy and non diabetic had idiopathic cystitis and mucous plug sounds very familiar. Get as much fluid as you can into him and as Bron said, if he's straining with nothing coming out, get him to the ER.

 

It could be a mucous plug or an actual blood clot. Either can cause a full or partial urinary blockage, which can quickly become life threatening (think hours, not days). Even if he is passing dribbles of urine and only has a partial blockage, it’s not always safe to wait.

Can you palpate/feel his abdomen to see whether his bladder feels full? UTIs can make them feel they have to urinate but there’s not much urine in the bladder so the pee spots are small. That can probably wait until morning, and it’s ok to encourage fluids.

A cat with a blocked urinate tract, on the other hand, usually has a HUGE, firm bladder (sometimes feels like they have a tennis ball or orange in their abdomen). Those are emergencies and you should head to the ER asap. And you should NOT push fluids, as you’re only adding to an already blocked and distended bladder, thus exacerbating the problem.

Urinary blockages can cause kidney damage, electrolyte imbalances, low body temperature, coma, and death. I nearly lost a cat to a blockage years ago, and he went from completely normal to critical in less than 18 hours. He barely survived, and thankfully I headed to the ER at 2AM. Had I waited until morning, he wouldn’t have made it.

Even if he is passing dribbles of blood or urine, if the bladder is huge, I’d consider him “blocked” for purposes of making a decision about what to do.

I don’t want to alarm you or cause an expensive vet bill, but if in doubt, please err on the side of caution and head to the ER.

 

There's two small clumps last night, so he was able to pee a little bit not nearly as much as his typical giant diabetes mats. I have an appt with vet today, what treatment should I steer them towards @Wendy&Neko and @JL and Chip

 

As soon as I kenneled him to go to the vet, he peed horizontally all over the kitchen floor like a race horse. Thick solid stream of urine.

Vet did an ultrasound, of course his bladder was empty by then. No stones.

They prescribed an anti-inflammatory pill (non-antibiotic). I asked if they could instead give me a liquid or injectable version, since Mister hates being force fed anything. They offered to do an injection at the vet for today, but refused to prescribed the injectable version long term. The vet wasn't sure if they could compound it.

Like my previous post alludes to, was this the correct treatment? How do we solve the mucous plug issue, which we know is happening due to me seeing it and having high resolution photos of.

 

Same thing happened with my cystitis kitty, but not until we got into the vet office. At least he wasn't blocked.

Which anti-inflammatory pill did they prescribe? My guy got Cerenia. Along with buprenorphine for pain, Cartrophen/Adequan and I started glucosamine chondroitin, which is supposed to help the bladder walls. I also put in Feliways, as he was a semi feral and stress could have played a part. Longer term, I switched to a low carb that was lower phosphorus with water added, as per https://catinfo.org/feline-urinary-tract-diseases/#Cystitis

Following on with JL's comment, I did get a vet to show me where the bladder is, right hand side of cat, so I could check how full it was.

 

Onsior (robenacoxib).

I haven't used the pills the vet gave me, just the one injection at the vet is all he got because he hasn't peed blood since.

I am hesitant to use Oncior again after reading this post: https://felinediabetes.com/FDMB/threads/cat-is-hiding.174394/#post-1912441

Is Fancy Feast Classic Pate not considered low enough phosphorus?

 

FF is pretty high in phosphorus. Check this excellent post along with the links in it to foods with low phosphorus. I now check all my foods and choose low carb low phos. Weruva and Wellness both show all this information on their sites and you do not have to calculate anything.

https://felinediabetes.com/FDMB/threads/fancy-feast-senior-varieties.262985/

I feel your pain. Henry has had cystitis since he was 4 yrs old along with 2 surgeries. He was blocked with crystals. Many trips to the ER. He was on special food which in turn led to the diabetes. Yikes. And the low carb high phos can lead to kidney problems. Yikes. So we have to be a step ahead and plan. Hope Mister is feeling better.

 

It's not an answer but I'm always happy to have transdermal BUPE in the house. Obviously we don't need Mister tumbling down the stairs but UTI's and stones are very painful. I've found over the last few years doctors and vets are becoming more oblivious to pain. When you know why something hurts it's one thing, the poor cat only knows it hurts.

 

Sorry for the silly question but what is transdermal bupe - i checked online and it said a skin patch. I never heard of that being an option but it sound pretty amazing. When Henry was in pain they gave him the 3 day injection which helped with pain but he was out of it badly. with the oral bupe, it did nothing for his pain. sounds like a patch is a great way in between. i had no idea that is an option, wish my vet would have told me. unless i am misunderstanding

 

Ordered Weruva BFF PLAY Chicken & Turkey Topsy Turvy (Soulistic Chicken & Turkey Pate). Hopefully he likes it. Fancy Feast Classic Pate is 25¢/oz (3oz cans), vs. Weruva BFF Play @ 35¢/oz (5.5oz cans). The 2.8oz version of Weruva is an absolute ripoff @ 58¢/oz.

Linking this post for future reference, has a nice Google Drive link: https://felinediabetes.com/FDMB/threads/fancy-feast-senior-varieties.262985/#post-2946915

 

BUPE is the standard painkiller when things really hurt. Our last sugar cat had a mouthful of rotten teeth that couldn't be pulled and absolutely hated the oral BUPE. We tried it in a bunch of different flavors and it was a total failure. Transdermal BUPE looks like toothpaste and comes in a syringe. You put a little blob inside the ear flap, then squeeze the flaps gently to work it in. It will leave a waxy buildup so clean the ears and switch ears every day. It comes from a compounding pharmacy and is expensive.
It might not be what you need right now but other members know I'm the transdermal BUPE guy, the mixture and dosing is always near the top of my profile if I'm not here.
I cannot emphasize this enough, this extended Noah's quality of life by at least two years. It never affected his numbers, never constipated him and we never had to keep him away from the stairs. Cat's do not suffer from withdrawal or get stoned unless you've really over done it.

It's a long story but for a good reason I'll always need pain meds. The worst month of my life was when my neurologist thought I'd be better off on a Fentanyl patch. I'm not Goody-Two-Shoes against drugs, again too long of a story but one day this might be you.

 

This is excellent information thank you. Wish I knew this earlier when he had his 2 surgeries and all the times he was blocked. Glad to know now and be ready to ask the vet for it when needed. No reason to keep a kitty in pain with all this wonderful modern medicine

 

Well said. The easiest things to say are often the hardest for others to understand. Pain is pain, it's not 1822 anymore.

 

@Roxana & Henry Just got the new food from Amazon. He absolutely loves Weruva BFF, he scarfed the bowl up way faster than normal.

 

Wedgewood Pharmacy formulates transdermal Buprenorphine. You can rub it on the ear (like Mirataz.) With orally administered Bupe, you have to make sure that it gets onto the mucus membranes (gums). Shoot it into the buccal (cheek) pouch and not into the main part of the mouth like you normally would with other liquid meds. It is very poorly absorbed in the GI tract and is absorbed through the mucus membranes of the mouth. Also, Bupe has a pretty wide margin of safety and some cats just need more than others.

 

I'm glad to hear this. I feed several of the Weruva BFF PLAY (pates) to my cats. They seem to like the Chicken and Lamb Laugh Out Loud flavor a lot. I switched many of my older cats to the BFF PLAY foods because they have low phosphorus and it's better for their kidneys.

 

Is this something that keeps for long periods of time? Sounds like a good idea to have this on hand preemptively?

 

@Noah & me (GA) didn't you say you keep it around "just in case."

 

What did I miss? I can definitely confirm "BUPE has a pretty wide margin of safety and some cats just need more than others".
Nigel spent his last week at home with cancer. We doubled his oral dose, then doubled it again. I was a bit shocked that he wasn't stumbling around, there was no vomiting, no constipation. At that point we weren't even watching his numbers, he didn't have long to go.
It was Noah that got us into transdermal. Both the label and our vet made it clear the words "as needed" meant just that. The transdermal is not a time release med in that form so I was free to split his dose into 3 or even 6 times a day as long as I wasn't overdoing it. Keeping the ears clean is a must as is working it in enough so that grooming doesn't get any on his paws.
I've had my own orthopedic/medical misadventures and really have to watch I don't project my own cringe factors onto animals. Yes they're quite stoic about pain but animals feel no joy in getting high, only relief. I don't have the link but cats don't suffer from withdrawal. Just the same I would always taper them off, they don't have the rationale to figure out why they went from no pain to even moderate pain. They will just accept it but why put them through it?

Kept in a cool dry place it will be good for months after it's best before date. You'll know it's gone bad when it turns from a toothpaste into something that can't be squeezed out of the syringe.
The mixture I've always been given is 0.16mg/0.1ml.
Noah's dose was 0.05ml twice daily, Andy's broken leg was three times daily or as needed.

Sorry all, there's no way to say this without sounding either like an ass or uncaring. We've been having some drama here so I often peek in first thing in the morning and then nothing for a day. It's no big deal, just life stuff. I'll put some more detail into the BUPE part of my profile where anyone is always free to check. It's not snooping.

 

Sorry, stating the obvious here. Using any medication past the best before date is a common sense thing that some people don't understand. My mom used to keep salad dressing until it was growing fur, I never did win that argument. The transdermal BUPE I've used after midnight on some specific day never caused a rash or some hideous blisters. When in doubt....