Expert: Jessica - 4/30/2010

Question
QUESTION: Our male cat (6 yrs. old) has blood/ bacteria in his urine, but no crystals. An ultra-sound last week showed he has a deformed bladder that has thickened, although it is small it is not tender. There is a small mass attached to the wall, but no stones. He is being treated with Convenia and Adequan (he also has arthritis), but there was no change in his urinalysis after 10 days. His PH is fine.
Can you suggest anything else I can do besides how the vet is treating him? I prefer holistic if possible. I give him Metacam for the pain. Any suggestions are welcome and thank you for your valuable time.

Janet (Mama) & Peety (patient)

ANSWER: Hi Janet.  I would recommend checking with the vet about also adding in a supplement such as Cosequin, Arthrimaxx or Zuke's Hip Action treats for cats, which are a combination of glucosamine and chondroitin and are aimed toward treating arthritis.  Chondroitin helps make up a mucus layer in the bladder, and evidence suggests that giving chondroitin orally may be very beneficial in helping repair the bladder lining.  My cats really enjoy the Zuke's Hip Action treats.

I'm not sure, but I am guessing that your cat has been diagnosed with interstitial cystitis?  All of your cat's test results seem to fit, except that this is generally painful.  Most of my cats with this condition have needed additional treatment with amitriptyline.  This is an antidepressant that seems to manage the condition because it has now been linked more strongly than ever to stress and anxiety.  It also has an analgesic effect.  My vets, even those which practice within the same hospital, don't necessarily agree on how effective it is.  However, having had several cats with the condition over the last 15 years, I have to say I believe fully that it works.  If you have a lot of trouble getting your cat's condition under control, I would strongly encourage you to talk to your vet about giving amitriptyline a trial run.  My cats have generally needed it for about 3-6 weeks until the flare up has subsided.  Some cats will need it longer term, or each time they have a flare up.

As stress is a factor with interstitial cystitis, some therapies that are aimed at reducing stress might also help, and I really like a product called Feliway.  I use the plug-in diffuser, called Comfort Zone, in my home at all times.  See www.feliway.com to learn more.  

Best of luck!

Jessica



---------- FOLLOW-UP ----------

QUESTION: Jessica,
Wow! You really know your stuff! I appreciate your sage advice and the time it took for you to answer me. I failed to include all the things I am trying with Peety. Not only do I use the Feliway, but I use Content-Um drops (L-tryptophan) and just started him on Elavil (amitryptilline) last week, but am still trying to figure out the right dosage for him.  My vet told me the Elavil would help chill-out Peety and even help his other meds work better in his body. I actually have two cats with arthritis, so am very interested in the Zuke's Hip Action treats. Could you tell me where you get them? I know my vet does not have them. Would a place like Pet-Co have them? What you said about a mucus layer forming and possibly helping to repair his bladder just stunned me. Is this what Chondroiton does in humans as far as the mucus forming around the joints? There are three vets where I take Peety and they all concluded he had a Urinary Tract Disease, but then nothing they have done for him has helped. The blood continues to stay in his urine, but he does not have crystals. This interstitial cystitis you think he has~will this cause the blood in his urine?  I figured he was in pain. Is the pain only when he pees or does he hurt all the time? When I was there on 4-22, I asked the vet to give him something for pain, so she gave him the Advil/ amitryptilline 10 mg 1 SID). She gave him a shot of Adequan (is this an anti-biotic?) on 4-14 and he'll get one more shot on 5-5. Is my vet on the right track or should she be doing anything else for him? How do you know when one of your cats is having a flare-up? I took Peety in because he was using the bathroom around the house and not using the litter box.

I hope I haven't confused you! Thank you for any additional help. Once I hear from you I will give you a superb rating!
Thanks, Janet

Answer
Surprisingly, some larger grocery store chains carry the Zuke's Hip Action treats for cats - that's where I first found them.  I believe Petco only carries the dog version.  But I order mine from entirelypets.com now.

Chondroitin is naturally found in cartilage and in the bladder lining.  Damage to the cartilage occurs with arthritis, and to the bladder lining with interstitial cystitis.  Initially, all of these supplements were meant to repair cartilage by replacing lost chondroitin.  Once it was discovered that interstitial cystitis was linked to a loss of chondroitin in the bladder lining, the importance of chondroitin to treat that condition was found, as well.  Supplementing Peety's diet with chondroitin won't CREATE a mucus lining in his bladder but may help repair the mucus lining that is naturally present, which is now damaged and thickened (inflamed).  

Essentially, what occurs with interstitial cystitis is that this protective mucus lining is damaged and inflamed.  This is what causes the bleeding, although in Peety's case, since he has a mass, this may account for some bleeding as well.  In some cases, the bladder lining may even become separated from the bladder wall, allowing urine to come in contact with the bladder wall, which is very irritating.  Blood in the bladder encourages bacterial growth, and the protective bladder lining is compromised, so it's not quite performing its job of keeping germs out as well as it should be.  This is why these cats are often positive for bacteria in the urine.  Convenia is an antibiotic that should help keep the bacterial infection in check.

Judging by how humans report interstitial cystitis to feel, it’s a very painful condition, and it hurts all the time, not just upon urination.  In fact, most cats that have it almost always have an empty bladder because they constantly feel like their bladder is burning and they need to urinate.  If he’s missing the litter box, most vets would agree this is a strong signal he’s feeling pain.  If he’d always been good about using the box, this is definitely an alert that he’s feeling significant discomfort.  This is actually the first sign that a kitty is having a flare up.  Missing the litter box, any sign of blood in the urine, or frequent trips to the litter box, and you should have a urinalysis done.

The Metacam is a decent pain reliever.  A few cats need a narcotic pain reliever such as buprenorphine or butorphanol for the first few days, but if Peety is still eating normally, this can probably be avoided.

Adequan is basically an injectable version of chondroitin and similar substances that have been shown to help with arthritis and interstitial cystitis.  This is why I would encourage you to talk to the vet before adding in an oral supplement.  I don’t think there would be any contraindications, but I can’t be sure.

It sounds like your vet is on the right track.  Hopefully Peety will be feeling much better soon!  Some cats can suffer long and hard with this illness, but with the amitriptyline, my guys have been under control pretty quickly.