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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
Satisfied Customers: 23438
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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My 13 year old female cat (persian/siamese) has been

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my 13 year old female cat (persian/siamese) has been struggling recently with blood in her urine. We noticed when she started urinating in strange places - she is otherwise happy and healthy. We took her to the vet, who prescribed metacam, suggesting she had a UTI. 2 weeks of that, and the problem remained. She then went on a 2 week course of antibiotics, which also did nothing.
We took her back to the vet, who did xrays, and took a urine sample (direct from the bladder) The Xrays showed no lumps or anything unusual, although her intestinal wall was thicker than normal.
The blood results came back showing lots of blood, but no signs of bacteria, infection, or cancer cells - but did show intestinal wall cells.
Since then we have tried medicated cat food (wet) designed for I/D - which she refuses to eat. We have also tried a raw food diet (after extensive research and purchase of all the various supplements required) which she seems to enjoy.
However, the blood and the inappropriate urination persists.
She is very dear to me and I would love to help her, but my vet seems unable to suggest anything other than forcing her to eat the medicated food.
Can someone help?
Gemma.

Hello & welcome, Gemma. I am Dr. B, a licensed veterinarian and I would like to help you today.

Now it sounds like you have done everything right here for your lass. Though given her urine results, this suggests that she has a stress cystitis/ feline lower urinary tract disorder. So, the diet change is reasonable (though we may need her vet to compromise with her to find something that will help but also she will eat).

Otherwise, our focus tends to need to be on bladder support, pain relief, and reducing stress. To start, we'd want to try to increase her water intake. So, make sure she has access to water (consider a kitty fountain, bowls through the house, flat bowls since she may have a smaller muzzle with her Persian heritage), try flavouring her water (ie adding spring water from tuna), cat milk and offering canned food.

Furthermore, since stress is so commonly a trigger for this in kitties (which can be tricky to pinpoint since as a prey species they will do their best to hide that they are stressed) we do need to address that too. Where possible, if specific stress triggers are identified, they should be minimised or avoided. As well, we can use de-stressing treatments (ie Feliway, Kalmaid, Zylkene, etc). Furthermore, make sure she has 'environmental enrichment' can cause significant stress. Examples of ways to address that would be to make sure to play with her often, given her supervised garden access if amenable, access to windows to watch birds/etc. And if she is targeting a few specific areas when she urinates out of the box, those may be areas she feels safer and a box should be added there as well.

As well, as this can be a painful condition for kitties to have, we do want to continue her on pain relief as needed. Further to that, you could have your vet dispense an OTC bladder supportive medication (ie Cystease, Cystaid, Cystophan). These are thought to support the bladder lining and repair the bleeding/ulcerated bits and in some cases some cats will be fine with just these as treatment. Finally, Amitryptiline is something we use for persistent cases but the above would be our next steps here alongside diet modification to help reduce her signs.

Kind regards,

Dr. B.

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I aim to provide best care for you just as I do for my own clients & their pets. If you have any other questions, please ask – I’m happy to help but please rate me with the **STARS** (or leave a written rating of 1-5; 5 being great) as this is the only way I am credited for my work by the site & this allows me to continue to help here. This is included in your question fee. Once you rate, your question will not close & you can still ask follow-up questions. Thank you. : )**

Customer: replied 12 months ago.
dear Dr B. thank you for your response- I appreciate you getting back to me.Ellie drinks lots of water daily - I make a point of changing her bowls in front of her, and she often drinks there and then if I tap the bowl. (perhaps a little Pavlovs training?) we have a feliway diffuser plugged in on the landing, which is a spot she likes to lie in often.she already has cystaid added to her food (I researched the product directly - it was not prescribed) and has been taking 1 capsule sprinkled on her food daily for about 8 weeks now.she does get out into the garden to sunbathe, although she's never been much of an outdoor cat so it's never for too long (I keep an eye on her since she is pure white and I don't want her to burn her ears) she likes to sit with our chickens who keep her company (they get along great)the vet mentioned enriching her environment so I've made sure there are toys in most rooms, and we play with her every evening - her favourite is the 'feathers on a stick - although it is a lazy game of her laying on her back and trying to catch the stick if it comes near.we cannot add a litter box to the spot she is urinating in since it is right by the front door, but I am installing a second box upstairs in the hope it might encourage her to use that instead.despite all this, we have seen no signs of improvement - so do you feel the next step would be more medication?I would prefer to keep her off medication if possible, but understand if there is no other alternative.I did look into cystitis/fuid but the blood results ruled it out so we moved on to considering feline ibd?I would be interested to know your thought s on this.kindgemma

Hello again,

Now I am glad to hear that you have started those treatments I noted though as you have just noted that she is going by the front door, I have to say that that seriously raises concerns of stress here. Cats that inappropriately urinated by doors/windows/vents tend to be reacting to cats outside. So,I'd be suspicious that a neighborhood cat is coming near your house or possibly even urinating out front and she is reacting to this. Therefore, you may want to consider putting a box as close as you can, else it may be worth blocking her access to that area to see if by reducing her being able to smell another cat there that we reduce the stress and with it the behavior.

Otherwise, I do feel that you may be confused with the results or what your vet has said. The urine culture would rule out bacterial cystitis. But neither urine nor bloods would rule out FLUTD. It is a diagnosis of exclusion and everything you have reported supports it. Furthermore, while the gut thickening could raise concerns of IBD (inflammatory bowel disease) it doesn't explain her urinary signs. IBD would not cause urinary signs, it instead tends to cause diarrhea. So, it could be an element of concern if she has diarrhea but not directly linked to these signs you reported. So, I do feel this is a stress induced cystitis with possible FLUTD. So,I would try blocking her access to that front door area along with your treatments; but if she doesn’t settle then medication would be the next step here.

Best wishes,

Dr. B.

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I aim to provide best care for you just as I do for my own clients & their pets. If you have any other questions, please ask – I’m happy to help but please rate me with the **STARS** (or leave a written rating of 1-5; 5 being great) as this is the only way I am credited for my work by the site & this allows me to continue to help here. This is included in your question fee. Once you rate, your question will not close & you can still ask follow-up questions. Thank you. : )**

Customer: replied 12 months ago.
Dear Dr B,Thank you - there are a number of cats in our neighbourhood, some of which we do know to be defecating in my plant pots outside the front door. I remove all sign of them but understand Ellie will smell them.She sits out there each morning (she moves to the back garden in the afternoon, following the sun) Are you suggesting that we stop her from havign access to the front?We are unable to stop access to the hallway and the front door, as is is the only route through the house. Her 'usual' litter tray is located very close by in the kitchen (it is a very small house!) and she uses that often with no trouble.Thank you for your explanation of the blood results - I wish my vet had told me that! His explanation seemed to rule out cystitis which is why I moved on to researching other options. Ellie does not struggle with diarrhoea at all - in fact, since we swapped her diet we barely notice when she 'goes', so I am pleased we can rule out IBD. Would you suggest we stop the raw food diet? I am aware of the dangers but would be interested to know your thoughts.I will look into ways we can discourage the cats from the front drive without upsetting Ellie further.Thank you for your input. You've been most helpful!Kindest regardsGemma.

You are very welcome, Gemma.

I am glad I could shed some light and that is good to hear that she hasn't IBD signs for us to worry about as well.

Furthermore, given this situation, I suspect it is those front yard "visitors" that are setting her off. So, she is allowed in the back garden (provided they aren't bothering her directly) but I would restrict her access to the front hall area as much as we can (perhaps just use a baby gait to limit her going as far as the front door/rug where she has been defecating) if we can to just remove that trigger for her. Of course, how to restrict/supervise always depends on a house layout and often we just need to trial options to fine one that works. But I would only suggest that as a short term option because as we do that, we'd want to see if we can deter their visits near the front of the house. It can be tricky but we may need to move those plant pots away from the front door. Or we could even try only having plants by the door that cats don't like (ie pungent odored ones like lavender, rue, geranium, lemon-thyme, citrus plants, Coleus canina). Alternatively, we can use ammonia, vinegar or citronella in the front yard (take care to avoid using high levels since this could harm any plants if too much is used). As well, fresh orange or lemon peel or tea leaves can put the kitty visitors off the area. And for stubborn kitties taunting Ellie, there are deterrent products on the market (ie Silent Roar, Haveaheart) or even motion activated sprinklers (Amazon carries these) that can at least deter them using the front door plant pots and again reduce the odors stressing Ellie out. And of course, all those options are safe for those kitties but will just make them think twice about coming up and marking the house area. And if we can just get them to leave the front door area alone, we'd hope to reduce her stress and settle her signs.

All the best,

Dr. B.

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I aim to provide best care for you just as I do for my own clients & their pets. If you have any other questions, please ask – I’m happy to help but please rate me with the **STARS** (or leave a written rating of 1-5; 5 being great) as this is the only way I am credited for my work by the site & this allows me to continue to help here. This is included in your question fee. Once you rate, your question will not close & you can still ask follow-up questions. Thank you. : )**

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