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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 30326
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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My 10 year old male cat has a lot of blood in his and

Customer Question

My 10 year old male cat has a lot of blood in his urine and has been on oral and now intravenous antibiotics for 3 months now with no improvement. He had a scan early in the process which showed no particular cause. He eats and drinks well, seems OK in himself and doesn't appear to be suffering (to our view anyway).
What could the likely cause be and what would be the best course of investigation/treatment to take?
Thank you in advance for your advice.
Submitted: 3 years ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 3 years ago.

Aloha! You're speaking with Dr. Michael Salkin I'm sorry that your question wasn't answered in a timely manner. I suspect that Cara Wiggins (name of your cat or you?!) suffers from idiopathic cystitis - an inflammation of the bladder of unknown cause. This is a chronic, sterile, inflammatory process and treatment is often frustrating for both clinician and owner. Risk factors appear to be male sex, being overweight, pedigreed breed, and stress factors - especially conflict with another cat in the home. Another study found no sex predilection, an indoor lifestyle, no access to outdoors for elimination (exclusive litterbox use) and a predominantly dry-food diet. The behavioral stress response is accompanied by immunologic, neurologic, endocrinologic, and vascular responses. Comorbid conditions include obesity, separation anxiety, gastrointestinal tract problems, and hypertrophic cardiomyopathy (heart muscle disease). These findings suggest that idiopathic cystitis is a disease process that affects more than the urinary bladder. There is no gold-standard test for diagnosis of idiopathic cystitis. A urinalysis and ultrasound of the bladder constitutes baseline diagnostic testing. Please let me know if a "scan" refers to an ultrasound or, instead, X-rays. An ultrasound also evaluates for cystic calculi (stones), mass lesions (transitional cell carcinoma, usually), bladder wall characteristics, and other abnormalities such as blood clots. Urine culture usually isn't necessary because less than 2% of these cats suffer from a urinary tract infection; hence, unless bacteria were cultured from Cara Wiggins's urine, oral and intravenous antibiotics are contraindicated. Please let me know if culturing the urine revealed infection. Current treatment recommendations are directed at decreasing the severity and frequency of clinical signs rather than being curative. Because increased inflammation due to a stress response occurs, the recommended standard of care includes environmental enrichment and stress reduction, increased water intake, litter box management, management of interactions in multiple cat homes, and potentially drug therapy (pychotherapeutic drugs such as fluoxetine/Prozac and fluoxetine/Paxil). Most of us will restrict these patients to canned food only which increases water intake. I could be more accurate for you if I knew the results of basic biochemical testing already performed, an ultrasound, culture and sensitivity of the urine, and Cara Wiggins's diet. A thorough checklist for cat owners can be found in Ettinger's Textbook of Veterinary Internal Medicine. In edition 6, it can be found on P. 1839 and copied for your perusal. Please respond with additional information and further questions or concerns if you wish.

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Expert:  Dr. Michael Salkin replied 3 years ago.
Thank you for your kind accept. I appreciate it.

Please continue our conversation if you wish.