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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
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Experience:  I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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As promised here is from Daisy's latest visit to vets. Have

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Hello Dr BAs promised here is a follow up from Daisy's latest visit to vets. Have pasted her report below. Sorry about the detail but thought you might understand the readings better than me.Anechoic urine, No bladder tumour evident. Bladder neck and wall NAD.
L. kidneys hypoechoic of R. Loss of corticomedullary definition.
L kidney is 3.75cm, right kidney is 3.97cm. R better definition.
Both kidneys hyperechoic renal pelvices, no dilation, no obvious uroliths or renoliths. No renal masses. Persistent low grade pyelonephritis no ascites.Spleen NAD.Liver architecture normal.
- ?. GB folded over as seem to be scanning x 2 fluid filled structures in area of GB No icterus or cs related to bile stasis. I would be grateful to have feedback on GB as to whether I need to worry or not. I presume as they didn't point out the fluid filled structures I don't need to. What was comforting from the report it did say No obvious abdominal masses. Renal values increased since last bloods. Although these have now been lowered since the renal food and antibiotics were introduced. The report finishes with ...think food is keeping things at bay, happy with results now.It also said haematuria assoc with renal dysfunction (likely chronic degeneration) vs pyelonephritis. But now the six weeks of antibiotics have finished they are no longer sure of the cause and that is why they have asked the advice of a urologist.My vet did phone the Urologist and they are willing to do a Cystoscopy to see what might be causing the blood in her urine. She does have a tiny bladder so it would have to be carried out with a small camera. When she said the words 'tiny bladder' this did set off alarm bells as I thought "ah wonder if this has been the problem all along".All through her history are bouts of cystitus. Wish I had been offered a cystocopy when Daisy was younger then I would have definitely risked it. Both the vet and the urologist did say as Daisy does not seem to be medically compromised they would advise not putting Daisy through this procedure due to her age and nervous disposition.This particular vet is very kind and supportive and did say that if I want to have the examination then they would refer me. Have decided not to go further.On the 27/7/2016 her urinalysis read as Blood +++, PH 7.0, Protein + Leucocytes ++ All rest negative. Laboratory reported haematuria still present, Still struggling to find underlying reason..Cat clinically unaffected. Genitourinary/Reproductive.I did ask for her to have cystophan to see if this can help improve her urinary health. Have started this today.Another vet looked at her lump, not too keen to put a syringe in as it is very close to the eye. He did say he was quite confident it was a cyst and not a tumour but admitted couldnt be 100% sure without a needle. He seemed a bit grumpy when I asked if Daisy could have her blood pressure checked. I said the reason I asked was that someone from Tanya's support group suggested that blood in urine might be a sign of of high blood pressure. He said Daisy didnt have BP done due to her nervous disposition. So no further forward on that one.I think they have done everything they can do and they don't want to see her till 3 months time., unless there are problems. Still wondering whether she should be on a longer term course of antibiotics due to the blood. So I have opted to test her urine at home every 2 to 3 weeks so I can monitor its progress.Many thanks...Emma and Daisy x
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. B. replied 1 year ago.

Good morning, Emma.

I have just received your message, so do let me have a wee read and I will post shortly. :)

Dr. B.

Expert:  Dr. B. replied 1 year ago.

Good morning again,

First, I am glad to hear that her scan was fairly unremarkable, since that does rule out some major worries. The gall bladder being folded is likely incidental, and not something we’d worry about since she has no signs of liver/gb issues here. Though I think that the persistent low-grade pyelonephritis (kidney infection) is significant and that could potentially be the root cause for her bleeding. We just don’t usually see bleeding in age related kidney degeneration and disease. In any case, I am glad that they are speaking to the urologist about Daisy and her challenging presentation.

Now it is a tricky situation at her age and a shame that this didn’t come to a head when she was younger. In an ideal world, cystoscopy would be great to let us get in there and see what was afoot. As well, while checking blood pressures is something we should do with all kidney cats perhaps when she is next in they will do so. Just to note, sometimes it can help to have them stay the day at the vets for periodic checks or as a home visit if they are nervy.

Anyway, one small issue that is still bothering me is that they have seen a persisting low-grade pyelonephritis. Ideally, we’d have wanted her vet to take an aspirate from the kidney under sedation for culture to see what bacteria is there and what drugs it is vulnerable to. (and that would be the perfect time to sample the facial lump too). But if that isn’t an option trailing the cystophan since she is a nervy cat and thinking about trying an alternative antibiotic with better kidney penetration may be something to consider. Though I agree that Daisy may be a challenge for her vet since she hasn’t been straightforward and since she is otherwise well. And that may be why they just aren’t sure what to do for her. So, monitoring and trailing the cystophan is worthwhile just now but we may just need to consider further antibiotics if they think the pyelonephritis is still there despite the previous course of antibiotics.

Best wishes,

Dr. B.

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Customer: replied 1 year ago.
Many thanks for this, reassuring as always. It is a shame as I know I probably would be more at ease if she did have a cystoscopy and a lump check but my nervous disposition is getting as bad as Daisy's lol. If the Urologist had said no go for it she will be fine then I wouldn't have hesitated. Slight problem with the cystophan there is a lot of powder and she just took one look and walked the other way, the tablet is too big to go in a pill pocket. Do they do a smaller or chewy version ? But many thanks as always. It's nice to have a second opionion.
Expert:  Dr. B. replied 1 year ago.

You are very welcome,

Those are always the challenge we face when they develop issues in older age. But if she is comfortable and otherwise happy, then that is the most important factor.

In regards ***** ***** Cystophan, I don't believe they do another formulation but you can add the powder to water or milk to syringe feed her or try mixing it into a canned food she really likes (or even tuna in spring water) to get her to take it as she should.

Best wishes,

Dr. B.