Wednesday, September 3, 2014

Feline Idiopathic Cystitis or Feline Lower Urinary Tract Disease

As I've mentioned elsewhere, Sothlice has never been an easy cat. When I first got him, I quickly found out he had allergies to something in the New Mexico air which caused colitis (yuck), but after we moved east, those problems cleared up and I had a blissful 9 months as the human of a normal cat.

Then one day in early March 2011, I decided to leave Sothlice home alone overnight. My brother was at my parents' house about 2.5 hours away for his spring break and he hadn't met Barley yet, so I decided we'd go for a quick visit and Soth would be alone for 24 hours tops. My parents didn't have a cat yet, so they didn't have a litter box set up unless we were visiting and it seemed silly to get them to cat-proof the house and to load Soth into his carrier for such a quick visit. In fact, I thought Soth might even enjoy a little alone time because he'd had two months with pre-meeting-our-trainer Barley. 

Sometimes a guy just needs a little peace and quiet.
When I got home early in the afternoon, everything seemed fine. Soth met us at the door and quickly ran to his bowl to let me know it was empty. Later on, I glanced in the bathtub and noticed a puddle of cat pee in the middle--and it was filled with blood and what looked like sand. (Warning: There is a picture of this later on in the treatments section.) Of course, I panicked. 

It was a Sunday night when I found this surprise in my tub, so, of course, our vet was closed. The emergency vet is about 30 minutes from our house and I had just spent a lot of money on Barley's xylitol poisoning (which I'll post about in a few weeks), so I was dreading the thought of rushing to the ER vet. I did what I always do when I'm panicking. I called my mom.

She talked me down from the ledge. Soth was still acting normal. He was eating, he was playing, he was able to urinate. So, I set the alarm to go off early in the morning, so I could be ready to call the vet as soon as they opened on Monday morning.

After visiting the vet, Soth was diagnosed with Feline Idiopathic Cystitis (FIC), also known as Feline Lower Urinary Tract Disease (FLUTD). We had a name for his problem, but that was about it. According to the information our vet gave me, 50% of cats with FLUTD will not have a cause that can be identified--even with testing. 

Soth was a month shy of his third birthday (at least according to his shelter paperwork) and the average age for cats with FLUTD is 4 years. FLUTD can cause cats to associate their litter boxes with pain, so they begin urinating outside of their boxes--Soth was no exception to this rule: my printer, my shoes, my carpet, his toys all became victims of FLUTD.

Often, Soth balances on the edge of his litter box instead of getting in it. That's one clue that he's associating it with pain.
Because the causes of FLUTD are elusive, it was hard to find the best way to treat it. There are basically two parts to treating FLUTD: first, you treat the episode and then you try to prevent future episodes. 

We started conservatively. We knew Soth had crystals in his bladder because of the sandy, gritty stuff I'd seen in the tub. The good news was that he didn't have a urethral obstruction, which can be fatal (and is not uncommon in male cats) and requires immediate medical attention. On several occasions, we tried to get urine cultures done to identify the types of crystals and to see if there was bacteria in his bladder, but Soth has always had other ideas (like dragging a blanket that was left in the kennel for him into the litter box and soaking up the urine before it could be tested or peeing on the vet tech while she tried to take him back to get a urine sample). To make a long story short, we have never been able to get a big enough sample from Soth to be able to get any definitive results from his urine.

This is similar to what I saw the first time I noticed pee in the tub. Gross. The blood is pretty obvious, but if you look closely at the dried puddle, you can see a few brown dots (especially on the right hand side). Those are the crystals that irritate his bladder.
To treat the current episode, we started with antibiotics in case there was bacteria causing the problems. We also added in some pain medications to help make him more likely to remember to use his litter box instead of seeing it as a painful experience. We continued that plan for a long time--any time he had an episode, the vet was a phone call away to give us another week's worth of pain meds to get him through the really bad episodes.

One of the theories about the causes of FLUTD is that it's caused by stress. Soth had definitely had stress in his life--I'd adopted Barley two months earlier. Another theory is that it is related to cats not getting enough fluids, which means their bladder isn't distended much and the urine isn't very diluted. We started with these two theories for our preventative care.

One of the first things we tried was switching his diet. We switched to the Purina Veterinary Diets UR formula, which is designed to adjust the pH level of his urine. Since Soth loves dry food, we did a mixture of the kibble and the wet food. The vet also suggested getting him a water fountain because many cats enjoy moving water. Soth took to the food immediately (he takes after me and lives to eat), but the fountain was a different story. He was terrified of it. He wouldn't go near it. I left it out for a week and finally was afraid he would never drink again if I left it out--it now stays in a closet.

To deal with stress, we tried anxiety medication since even if Barley was the cause, she wasn't going anywhere and we were going to have to find a way to deal with it. First, we tried amitriptyline in pill form. Amitriptyline is an anti-anxiety medication that my vet hoped would reduce anxiety and inflammation. Soth wouldn't take it. I'd swaddle him in a towel, pop it in his mouth, and he'd hold it in his mouth and spit it out the second I put him down. I tried pill pockets. He would eat the pill pocket from around the pill and leave the pill. I tried hiding it in wet food. He wouldn't eat the food. We switched to liquid every 12 hours. I'd never had problems given him antibiotics before, but I guess amitriptyline tastes much worse than antibiotics. He'd foam at the mouth, drool, vomit. After a few attempts, he knew when I'd be coming for him and he'd hide. And he is a champion at hide-and-seek. It was causing both of us more anxiety. Our vet found a third option--a topical form that came in a tube with an applicator that you rubbed in his ears. Soth didn't mind that at all, but it did have a weird side effect. His cute little pink ears started getting discolored--little brown spots started showing up. He didn't seem to be bothered by it at all, but I was afraid I was burning his skin. The vet checked him out and didn't see anything to be concerned about.

We also tried to make the environment more tailored to Soth. My mom and I built him a cat tower that was the perfect height for looking out the back bedroom windows where he likes to watch birds. I bought him a multi-tiered cat tower for the living room. Another vet suggested using Feliway diffusers in the house. He seemed to enjoy all of these things, but I have no idea if they made a difference.

He also has more beds than any one cat could ever possibly need.
And has access to two human beds in the apartment.
And a few dog beds.
Months passed with using the amitriptyline, which can take several months to work. We continued for over 6 months and nothing changed. In fact, it seemed like things were getting worse. I was spending all my free time following Soth around with a roll of paper towels and carpet cleaner. I even bought a steam cleaner--and he peed on the steam cleaner! Finally, I had to make the decision to take Soth off of amitriptyline because at $80 a month, plus the costs of the prescription diet, it was really adding up and not making any difference for my little dude. We stuck with the prescription food because he was producing more urine at a time than he had in the past.

Our vet said Soth had the worst case of FLUTD she'd ever seen, so she took some x-rays (which we'd also done early on to make sure Soth wasn't at risk for becoming obstructed) and she consulted with another vet who had been successful with flushing bladders out with a mixture of saline and steroids. She was going to take a sterile sample of his urine directly from his bladder and send it to be cultured. We scheduled the procedure in February 2013 (that's right--we had been dealing with this for almost 2 full years). 

Things didn't go as planned. Soth's bladder was so small and so hard that the vet couldn't get it to distend enough to take in all of the solution--or even half of it--that she was going to use to flush his bladder out. This also meant that his bladder couldn't distend enough to hold enough urine to get enough for a good culture. Our vet's best guess is that the crystals that he'd had pretty much non-stop for two years had created scar tissue in his bladder that kept it from being as flexible as it should have been.

There is good news, though. Apparently, something about the tiny bit of solution that got into his bladder helped heal the bladder lining. All of the sudden, he was using his litter box more regularly and producing A LOT of urine. At the follow up exam, the vet said that his bladder felt more normal and healthy than it had in a long time (Remember the happy dance I was doing at the end of this post?). 

Where We're At Now
2011-2013 was one of the most difficult periods of my life. There were many times that I wondered if I needed to consider euthanasia because I was seeing my boy in pain so often--but he was still enjoying life by chirping at birds and squirrels, enjoying his food, and playing regularly. My heart broke continuously during those years.

Things still aren't perfect. Most likely, this is something that we'll be dealing with for the rest of Soth's life--although some research suggests the problems tend to clear up in senior cats and at age 6, Soth's almost considered a senior. But I am happy to report that things are as normal as they ever get around here.

Barley might have been the cause of stress once upon a time, but now Soth thinks she is best napping partner.
I now have three litter boxes in my 2-bedroom apartment and gave Soth several different options of types of litter before narrowing it down to his favorite two (which THANKFULLY are the most affordable options). Occasionally (we're talking a couple times a week rather than a couple times an hour), he still finds a spot outside of his litter box to pee in, but I no longer feel like I'm solely responsible for keeping the companies that make carpet cleaners in business. 

We haven't picked up pain medicine from the vet in over a year and haven't had to have any FLUTD-related checkups since his procedure in February 2013. (Although we did attempt to get another urine sample before his teeth cleaning this year--which is when he peed on the vet tech instead.)

We've switched his diet a bit. He is still on the Purina Veterinary Diet UR formula for dry food, but he quit eating the wet food (he has never been much of a fan of pate style food). Since he still needed the water wet food provides, he now eats Purina Pro-Plan wet food (3 cans a day!)--which isn't ideal since it doesn't have the same attention to pH levels as the prescription diet, but it's better than starving him or not giving him enough water.

Sometimes, I still find blood and crystals in his urine, but it's rare. Cats with FLUTD can go through cycles where they are fine for months and then have a week or two of a FLUTD episode with pain, crystals in the bladder, and blood in the urine. Soth still has these sometimes, but it's nothing like when he had these symptoms non-stop for almost 2 years.

One of the hardest parts of this experience has been the lack of answers. There's really no way to know if all of the beds, towers, and litter boxes to make Soth feel like king of the castle helped. It's possible the timing of the bladder flushing and the improvement are pure coincidence. Who knows if the diet has had any effect on him? We are so thankful that our vet has worked so hard to find ways to manage his symptoms and help us prevent future episodes. If I could change anything about our treatment plan, I would have been more persistent that the anxiety meds weren't working--I don't think our vet fully grasped just how bad Soth's case of FLUTD is at first, so she didn't suggest doing x-rays that led to the bladder flushing until we'd been dealing with non-stop problems for two years. Maybe things wouldn't have gotten so bad if we tried the flushing earlier on.

There's no point in dwelling on what I could have done, though. We did the best we could for Soth at the time and now, most of the time, I have a happy, healthy kitty and I treasure our time together.

See all posts from the Caring for Critters Round Robin here
We're participating in the Caring for Critters round robin hosted by Heart Like a Dog where pet owners share their experiences dealing with health issues so that other pet owners have more of a support system. Be sure to check out Tales from the Backroad's post tomorrow!

*Disclaimer: I am not a veterinarian and have no medical training. The ideas shared in this blog are my own experiences with my cat's struggles with FLUTD and I shared them in hopes that other cat owners going through this disease might not feel as helpless and alone in their experiences and to provide hope that things can get better. If your cat shows symptoms of urinary problems, seek veterinary attention.*
Feel free to share this with anyone who might be sharing their life with a cat with FLUTD.


  1. Poor Soth!! It sounds like you've been through hell! :( My male cat, Hurley, had a urinary blockage 2 years ago. He had struvite crystals.. It was a total nightmare. Before the blocked we were having issues with behavioral peeing. He doesn't really get along with my other two cats, we went in for urinalysis after urinalysis and they never found anything and then 6 months later he blocked. He had to stay at the vet for a week and after he came home his recovery was horrible. He's okay now, though but still has occasional litterbox avoidance.. Sigh.. I'm right there with you about feeling like you are paying for the carpet cleaner companies. It has really sucked.

    1. It sounds like you've had a rough time, too! I'm glad that Hurley recovered from his surgery and is doing well. Urinary problems are horrible; not only do you have to handle the stress of a sick pet, but you have to deal with the terrible side effects on your carpets! I've started using a vinegar/water combo in my steam cleaner because it cleans the floors well and vinegar is much much much cheaper than all of the cleaners I was buying.

  2. Wow, poor Soth and poor you!! I'm glad he's feeling better now, that must really be such a relief for you.

    My daughter joined the Army and left her two cats with her boyfriend, turns out she and the boyfriend split up but he still kept the cats. One of the cats, Bob got sick and my daughter asked me to get him to the vet. Turns out he had something going with crystals in his urine. He was very sick for a few days, but my vet got him sorted out. When he came home (to live with us, until she could take him back) he was on wet food only and nothing with fish in it. It worked, because he came to live with two big dogs, but never missed his litter box and was sick with that again.

    Thanks for adding this to the Round Robin, it's a great contribution!

    1. I'm glad that Bob had so much success with moving in with the dogs and never having litter box problems! Soth loves his sister now, but I think it just got so bad so quickly that things kind of spun out of control. I had no idea urinary problems were so common in cats until this experience happened!

  3. Poor lil Bun. He does seem MUCH better now though! I'm glad you have a vet that doesn't give up!

    1. I'm glad we have our vet, too! Of course, Soth's latest episode coincided with you coming to visit and leaving him behind--Soth loves his aunt L!

  4. Thank you for sharing your story. I am so sorry it was such a challenging and painful journey. It sounds like you did everything you could!

    1. Thank you! At times, it felt like I wasn't doing anything--but now I know that the vet and I did everything we could and it has helped!

  5. Glad to know that Soth is doing so much better now! I have to agree that UTIs in pets are tricky and frustrating to deal with, as I've recently found out with my dog Destiny (I will be posting about that in October as part of the Round Robin). Great informative post! Thanks for sharing :)

    1. I'm sorry you have had to deal with urinary problems, too! It's definitely not easy or fun! I'm looking forward to your post!

  6. Poor Soth and poor you too! What an absolute nightmare it must have been at times. I had a cat that urine sprayed in the house a lot (although she didn't have FLUTD) and it was just soul destroying. I can't even imagine how I would have felt had she been in physical pain as well. Thanks for such an informative, helpful post on a very difficult (but common!) problem. I hope Soth continues to do well x

    1. Soul destroying is an excellent way to describe it! There were definitely days when I felt like I didn't do anything else except clean up cat pee.

  7. Finally getting around to reading all the posts in this series. This was a very informative and accurate post. I'm sorry you have gone through this condition with your cat, I'm glad you never gave up and are managing it. I am a veterinary technician and too many people give up and take their cats to the shelter.

    1. The part of me that adores my cat no matter what can't understand how people could ever give up their pets for something like this, but the part of me that spent every waking hour of every day for months with a roll of paper towels and a bottle of urine remover in hand can understand people who give up. I think knowing there are other people out there who understand the frustrations can be a big help in finding the strength to keep working at it. Thanks for reading!