It is finally starting to feel like spring is here, even though we are having bouts of snow and it is still very cold. Something about the sun feels more spring-like. Maybe the feeling is induced by the yellow roses and pink tulips Dimitris surprised me with yesterday, which feel like very spring-y flowers. In reality, I wish the occasion for them was a bit happier. He dropped them off as a “get well soon” present for Rigel, who is once again having urinary problems.
Ever since his issues from years ago, after which he had a Perineal Urethrostomy, he has been more prone to bouts of idiopathic cystitis and infection. We’ve been “free” of it for the last few years, but it was bound to happen eventually.
On Monday morning I noticed him repeatedly trying to go to the litterbox, over and over again. At the same time he began to sniff for other places to pee. He tried to go in the remnants of his old box, which had been sitting empty next to the front door waiting for a trip to the recycling station. He also kept going out on the balcony and trying to pee in the dirt of last year’s plant containers. He looked uncomfortable and was vocalizing. I quickly checked for signs of blockage, by checking if he was getting any pee out in the litter and also checking the urine on his fur. Luckily with a PU surgery having been done blockage was less likely, and he was getting pee out - it was just drops, likely because his bladder was empty from frequent urination. I checked for any signs of blood, which can often be spotted in the color of the litter or on his fur, and didn’t notice anything. It was more likely that he was very irritated and in pain, and kept feeing the need to pee even though there wasn’t much there. This all happened within a span of about 15 minutes, and I called the local vet clinic right away to make an appointment.
Unfortunately they had no spots available until the next morning. I decided to book that and watch him closely, since if he got worse we’d need to go to a different emergecy hospital before the appointment. I also started to call another clinic to get an appointment sooner, but by that point he seemed to have begun acting fine - eating, playing, tail up, and he seemed to stop pacing to the box. I decided to start off by waiting until the morning, because the local vet clinic was within walking distance (about a ten minute walk). Feline Idiopathic Cystitis is known to sometimes be triggered or exacerabated by stress, and walking him over to the local clinic near home would be less stressful for him than being put in a taxi and driven elsewhere, especially because we take our normal harness walks around the area as well. I decided that since he seemed to be mostly fine we would wait for now.
He seemed to be largely fine for the rest of the day, to the point that I thought maybe the issue was already resolving. That night he started going to the box more times than usual again, but I saw him getting out some nice pee clumps so it was clear that he was emptying.
The next morning we got ready to go to the vet, and about 40 minutes before our appointment the vet’s office called and said that the vet was sick. Crap. The next slot they had would be Thursday morning (it was Tuesday at the time). We booked that since he was acting pretty normal at that point and it seemed OK to wait some more, of course still with the understanding that if he got worse he’d go to the emergency room.
He seemed to continue to get better, aside from slightly more frequent urination than usual in the morning and at night. On Thursday morning the vet examined him and said his bladder felt small and soft, a good sign that he was getting urine out well. She also felt his spine for signs of pain and didn’t feel anything, as sometimes pain can trigger cystitis. She suspected it was idiopathic cystits. We discussed maybe doing an ultrasound and an x-ray after giving him a sedative, but I was cautious of putting him through a bunch of procedures again after everything he’d already been through. He was already very agitated at the vet, and putting him under more stress could make him worse. The vet agreed and said that as long as he is eating, drinking, and acting fine we can start with a blood test and some anti-inflammatories in the meantime. Then if he does not get better or if the blood test shows something off, we can come back and run more tests.
Unfortunately they did not let me stay with him during the blood drawing like I normally would. Usually I hold him to help calm him down. Each visit to the vet with him seems worse. He is very vocal in his hissing and growling, but has never so much as made a move to bite a person. So normally I hold him and it is fine. This time because I could not be there to hold him, for their safety they decided to put a cone on him, which he hates. But the test seemed to go OK. Afterwards because the vet was so close to our house we took a walk back home. He enjoyed sniffing around in the grass and trees, and it seemed to distract him. He was walking around bright eyed and bushy tailed our way back to the house. Unfortunately though at that time I noticed him trying to squat repeatedly in the grass again, trying to pee. This is really when it was very pronounced - he seemed to get worse again in terms of urination frequently.
I picked up the anti-inflammatory medication the vet prescribed right away. He cannot tolerate Metacam, so she tried a different NSAID (onisor). Unfortunately it seemed to make him vomit and act lethargic for some time, similar side effects that he gets to Metacam. We almost rushed to emergency, but just as I was getting ready to make a call to the taxi he seemed to get better and liven up, and was soon back to his “normal” self. When I was sure he was OK, I called the local clinic and told them what happened. They said to discontinue the NSAID, and that the vet would call me the next day.
The next day (Friday) the vet called us. She wanted to take a urine sample, originally with a needle in his bladder. I asked if it was possible for me to deliver a sample myself taken at home to start with, as I’d like to avoid sticking anything in his bladder any more if at all possible. It had already been severely damaged earlier, and the less we can mess with it the better. Although of course this won’t always be avoidable, but I always prefer to ask about the option.
The vet agreed that I can bring a sample myself at first, which I could likely do faster than we could get an appointment for them to do it anyway. I usually manage to get a pretty “clean” sample also, as over the years we’ve gotten used to my holding a measuring spoon directly under him when he pees so that it does not come into contact with anything except for his own fur (which I realize could introduce some contamination, but not as much a say if it had to be scooped from the box of litter). The idea is that they will test the sample for things like infection. If anything in the sample is not enough or looks uncertain, we will go ahead with doing the needle-obtained sample in the vet’s office, and the idea is to also do a followup appointment next week or the week after anyway (if not sooner, depending on how he is doing). At the same time she prescribed him steroid anti-inflammatories instead. He tolerates these better, but it would mean if he does have an infection they could suppress his immune system and make it more difficult to fight.
I gathered the sample a few hours later, strategically waiting until he had a nap (ie enough time for his bladder to fill up a bit), and ran it over to the vet within about ten minutes (the fresher the better!) Unfortunately when gathering the sample I saw that it was red - there was blood in the urine that wasn’t visible in the litter color or on his fur. This is common with inflammation, but I was so disappointed. He was acting “fine” so I was hoping this was a really mild case, but seeing the tinge of blood in his urine just reiterated how serious this might be. And considering it started on Monday and it was now Friday, with one medicine that didn’t work and the other which was just prescribed, he had been in pain for a week.
At this point I was/am thinking that I made the wrong decision in waiting to see the local vet - he needed treatment sooner. Usually I’m not averse to going straight to emergency and we’ve done it plenty of times, but his overall “happy” behaviour and the desire to keep him less stressed at the visit by going to the local vet clouded my judgement.
So now he is on steroids (to get his second dose this evening), and we are waiting to hear back from the vet about the urine sample. He is still urinating frequently and in different boxes/locations. We will likely need to go back to the vet next week for a followup and potentially an ultrasound, depending on what the urine sample shows. He is still eating, cuddling, etc, so I just hope that he isn’t in too much discomfort overall.
“Luckily” I have been prepared to deal with him having urinary problems over the years after what he’s been through and know how to take a sample, notice symptoms of obstruction, convince him to eat if he’s not feeling well, give him meds effectively, etc. I knew that after what happened to him earlier he’d be more prone to these things recurring, and have prepared myself for that in practical terms. But emotionally each time he has problems with his bladder I get what feels like flashbacks to that nightmare month when he was a kitten and not only get afraid and worried for what it is going to be this time, but also feel like I’m re-living the entire experience from scratch again, from the initial discovery of his blockage, to countless nights at the vets who can’t figure out what’s wrong, to having to book a vet to put him to sleep. I just try to remind myself that it’s a miracle he’s still alive and that I’m grateful for any extra day we get.