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Feline Lower Urinary Tract Disease (FLUTD) is defined in our textbook as “ a multifactorial syndrome where not all causative agents or combinations of contributory factors are known.” In plain English, that means “We don’t know why your cat is so sick, but here’s what we think it is.” As a technician, this is extremely frustrating because you’re taught that if a pet is sick, we give it medication and it gets better. Most of the time, it’s true. With FLUTD, nothing is simple until the very end and unfortunately, some owners run out of resources and even out of hope before the cat has a chance to be maintained. This is my cat Fortune’s story. It is not only a portrait of a cat with FLUTD and how we got her stabilized, but an informative story for anyone whose cat is suffering the same way and doesn’t understand all the clinical terms the vet may be throwing at them. Please feel free to pass it on. We found Fortune in a shelter in Colorado in 2001, and fell in love with the gentle cat who licked our hands and elbows right away. Originally, I had intended on adopting a younger cat, preferably short haired, to be a companion for my solitary cat Mima while I was at work and school. We came home with a long haired tortie who was estimated to be about a year older than Mima and continually tried to clean her ears. From the start we knew she was not going to be an easy cat to care for. Within the first year we had her she lost a good amount of her teeth due to chronic infections in her mouth, and we started setting aside money each year for her dental care. But it wasn’t until we moved down to College Station that we discovered there was a real problem. I was sitting on the couch reading one night when I noticed that Fortune was wandering around the house, squatting every few inches and acting like she was trying to urinate. I was immediately concerned because I recognized this as a symptom of a urinary tract infection, and made a note to myself to take her with me to the veterinarian in the morning. The situation became quite a lot more urgent when I went to pick her up and discovered a puddle of bloody urine under her tail. Immediately, I called our clinic’s emergency number and on the advice of Fortune’s doctor gave her an antihistamine to help her sleep and stay out of pain until morning. By that time she had started crying every time she squatted and the blood was becoming more and more evident. She fell asleep quickly, but I stayed awake most of the night watching her and stroking her head. The next morning I took her in at 7:30 before the general public even comes in. I didn’t work until the afternoon so I had to leave her and get some things done. I gave the okay for them to do bloodwork, a urinalysis and whatever else she might need. Being that I worked for the clinic, I wanted no expense spared for her. When I returned, I discovered that Fortune’s bladder was full of blood and pus from the infection that she had been hiding from me, possibly for several days. Her urine was also filled with tiny, sharp edged crystals that weren’t even identifiable at the time. The oddest thing about it was that the pH of her urine was normal, which doesn’t match the presence of crystals in her bladder. The vet suggested an ultrasound and I agreed. If we saw large stones in her bladder, Fortune would have to undergo surgery to remove them immediately. If not, then we were looking at a whole new sheet of options. The ultrasound revealed that there were not several large stones in her bladder, but rather hundreds of tiny crystals that swirled loose and formed piles at the floor of her bladder, causing the irritation she was dealing with now. The only question now was what was causing these crystals to form in such quantities if not her urine pH? The next step was to culture her urine for bacterial or fungal organisms that might be the culprit. In the meantime, I was to begin flushing the crystals out of her system by giving her large amounts of subcutaneous fluids (an electrolyte solution injected directly into the space between the skin and muscle) twice daily at home. In addition to this, she was prescribed a bladder relaxant, a supplement, two antibiotics and a morphine-based pain reliever in a syrup to be given throughout the day, and a diet of canned cat food only. The bill for that first day’s treatment was over $700. Fortune did not like the medication. We fought three times a day to try and get it into her mouth and then fought another two times in the morning and night to give her the fluids. She hated the fluids most of all. I couldn’t blame her; the needles were huge and I couldn’t warm the fluids as well as I could have at the clinic. After the first two days, I would have to drag her up the stairs, both of us crying as I begged her to cooperate. The looks she gave me broke my heart. Her first urine culture came back negative, and we continued the medications, which by now had started giving her diarrhea. I had taken to putting newspaper down all over the floor of my living room in case she couldn’t make it to the litter box, which was about 90% of the time. I discovered then that she had developed a phobia of using the box because she associated it with being in pain. So there I was with a 7 year old cat who had to be re-trained to use the litter box and who cried every time she saw me coming. Very slowly and through the use of all natural kitty snacks, I managed to teach her that the litter box was not going to hurt her and praised her lavishly each time she used it. The other cats were starting to think I was insane and wondered why they didn’t get snacks when they used the box. This began the 4 cats vs. the litter box battle that is still keeping the cat snack company in business. Everything was looking good until about 3 days from her progress exam when I noticed her squatting frequently again on the newspaper I kept piled on the floor. We returned to the clinic the next day only to discover that the infection had returned, and the urine that was drawn out of her bladder by the cystocentesis was dark red. Another round of antibiotics was prescribed and more pain medication. We sent the urine out for another culture to see what kinds of bacteria were causing this, but nothing grew on the plate. Fortune and I suffered through another round of subcutaneous fluids and bitter medication compounded into syrup. Her veterinarian told us that if the second round of fluid treatment didn’t flush the crystals out of her bladder we would have to put her under anesthesia and manually push them out by pumping fluid directly into her bladder, then draining it through a large catheter. The procedure and tests would cost us another $1000 at least, added to a bill that had managed to steadily climb to a little over $2500. Once again we changed her diet. I began feeding her nothing but special hypoallergenic canned food made of rabbit and green peas and softened it with 2 parts water to ½ can of cat food. Increasing her fluid intake is one of the steps we were advised to take to keep the fluid constantly moving out of her bladder in order to flush out the crystals. We had already installed a pheromone diffuser in each level of our house to reduce her stress level and were doing all we could to make sure she got more exercise and lost some weight. This time our luck seems to have held out. Fortune has not had any problems since her last emergency visit to the vet, and her last urinalysis showed no evidence of blood, crystals or bacteria. For the time being she is a healthy (2 pounds lighter!) kitty who loves playing with her baby sister Miko and actually begs for more water with her meal. We have not had to do the surgery and she is off all but one of the medications. FLUTD is a very frustrating disease, mainly because the treatment options you have are somewhat subjective. Reducing stress, maintaining an ideal weight, eating a pH neutral diet and increasing fluid intake are the four main “walls” of the house if you will, but sometimes this is easier said than done, I’m afraid. When we first adopted her, my husband and I toyed with the idea of changing her name from Fortune, which the shelter had given her. These days we’re glad we kept it, because she has brought so much good fortune into our lives and we into hers. Of course, no credible writer would ever overlook the double entendre. It’s too good.   |
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