Chronic FLUTD/FIC due to physical trauma?

[macka]

Hey all, I'm asking here because I'm struggling with one of my cats (Penny). Penny seems to be suffering from chronic flutd/fic but my sister and I have no idea what would be causing it. Or rather, HOW would it be causing it.

So, to get some things out of the way:

• I also have two other cats (Pippin and Soot) who can be somewhat intense with Penny so I do genuinely keep all their interactions to a literal minimum.

• All cats are on 100% wet food diet, and Penny has also been on a specific medical diet for flutd/fic/urinary issues (Royal Canin, Hill's, Animonda Integra, Kattovit..) for years now.

• I have at least 5 litter boxes spread throughout my apartment. They are cleaned frequently throughout the day, every day. I use clumping litter.

• I also use Feliway/Felisept inffusers throughout the apartment etc to help with calming down or stress or whatever.

• All cats are NOT free-fed, they have their meal times, and they eat separately so there is no food being stolen from another cat etc.

I realize stress can be a factor (and I do think/recognize it IS a factor for Penny), and I know Penny is an easily stressed/timid/shy cat. But I am at my wit's end to be honest.

Every few months: she essentially cycles with struvite crystals, then we go to the vet, she gets pain meds, anti biotics, anti nausea meds, and meds to stimulate appetite.. and of course, all this time she is on her medical wet food for urinary issues. Then it's back to "normal" (but not really), and then again. And then every time during these vet visits, when we do like a quick urinalysis test...her pee is always showing some crystals in her urine and her leukocytes are 3+, and her urine pH is 6.5. Everything else (blood work, the rest of urinalysis) is normal, more or less.

But we are constantly dealing here with a cat who is holding in her pee (unless we're at the vet or we have to bathe her because she has pee or poop all over herself, then she just releases the waterworks!), and then either 1) strains to pee some times, 2) holds her pee so long that she isn't aware it is there, and then she pees over herself in her sleep (either a tiny amount or the whole amount), 3) when she is better, she does go pee on her own and manages to pee a good amount but you know..it literally happens SOME times and SOME times it does NOT. But related to point 3), her "better phase" doesn't last too long, and we are back at square one.

So, physical trauma? When she was 1-2 years old (she is now 13 years old), she had an accident where she was outside exploring but unfortunately got hit by a car. She luckily and thankfully survived, didn't have any bone fractures. However, at the time of the accident, due to the physical trauma, impact and shock- she couldn't walk so she dragged herself by her two front paws, and she was constipated and blocked. In that time, we took her to the vets where one confirmed with an xray that "yay, no bone breaking" and then the other one confirmed with an ultrasound that she was backed up. So, we tried to administer oils or whatnot (this was so long ago, I don't really remember, and I was a tween back then when it happened, and also of course the vet was administering all those things) to help her poop and stuff. It was not happening. So after this long week, she ended up having an operation where they emptied her out. After this, she (as well as my other cats) are now 100% indoor cats only.

Since then:

• Very soon after her operation, she very quickly regained the ability to walk (a miracle!) but she is walking in a way that it's obvious that something is wrong with her back legs and she is also dragging her back feet with her (understandable)- however all this hasn't stopped her from climbing or running around my apartment etc

• Due to her back legs, she can't put herself into the regular pee or poop cat pose that a healthy cat would do when going to the toilet- either I (or my sister) help her with the toilet where we hold her above the litter and then massage her lower abdomen area to help stimulate her to pee or poop depending on what she needs OR when she goes by herself, she sort of plops down with her butt on one side and then goes

• She also struggles to poop, so she does deal with constipation some times and slow mobility of her intestines, I think

I know from this, that she has issues with her lower spine and whole lower abdomen nerves/nerve tissue, where her bladder and intestines/colon are located. With the holding in her pee, and then peeing in her sleep..my vet described it as overflow syndrome but I only agree with it partially since there ARE times when she does feel the urge to go, gets up and then goes to the toilet (when she's doing "better").

And for her back legs/lower spine/nerves, she never had an MRI or CT or PET scan done and I don't know if that would help? Because like all those years ago, previous vets never mentioned doing anything of that sort. I don't even know if we had that technology for pets in my country back in 2010/2011 when the accident happened.

I don't even know if it's even possible if her bladder tissue is messed up due to the nerves?? Like if her nerves deteriorated (most likely) and then because of that, the bladder lining/structure changed or whatever, which then causes it to not be a good place for urine, and then her urine changes into a mess that's causing her issues etc. It's like a dark circle where there is no end in sight.

I'm just completely lost and don't know what to do.

I don't even know what I'm expecting what I'll find, but I just know that for the time my cat has left to live- I don't want her to spend that time in pain.

Because it happened again, 2 weeks ago, she was struggling to pee YET AGAIN, we took her to the vet- quick urinalysis test shows struvite crystals but some tiny amount of calcium oxalate stones as well, leukocytes 3+, pH 6.5, some blood. After a week of pain meds, anti biotics, anti nausea meds (along with her urinary food), calcium oxalate stones are gone, blood is gone, everything else is negative, but her leukocytes are still 3+ and she still has big amounts of struvite crystals present. Today we had a vet check up where we did a full blood panel (everything was fine), and we have done urinalysis test where they take urine straight from the bladder with a needle so we're waiting on tests for that. Also did an ultrasound and there were no physical objects or blockages. I just don't know anymore.

It's literally constant.

[fjm]

I wonder if it is time to seek referral to a specialist - perhaps neurological as well as genitourinary. If the nerves governing her bladder control are damaged, which sounds probable from what you describe, that could explain her intermittent control and that in turn could help to explain the crystals and other issues. If the underlying cause is nerve damage and the accident was so long ago that it is unlikely that her nerve function will improve further at this stage, then it is down to getting the very best management routine in place that you can. I would be looking to review diet, fluids, drugs, supplements, frequency of manually helping her to void urine and faeces, etc with a specialist. Just increasing the amount of water she drinks by offering her the unsalted water chicken has been cooked in, or installing a fountain, might help a little with the crystals, although check with your vet first, of course.

[Mollycat]

A neurology opinion sounds like a good plan to me.

I know there are a million differences between us and cats because of our bipedal stance just for starters, but I do have nerve damage in the same area and I can tell you from experience a little inflammation caused by something as small as a false move can make you unable to pee and that is quite distressing when it happens. The nerves responsible for enabling elimination come from a different vertebral joint to the nerves controlling motor function in the legs. What can happen in road accidents is the tail can be trapped momentarily as the cat is running away, resulting in a sharp pull on the tail which can damage the spine and spinal cord.

With the expensive scans you would have to ask a neurologist about the options for care - put it bluntly, sometimes there is no sense in expensive diagnostic tests if they don't change the treatment options. On the other hand physio and even hydrotherapy can really help, so only the specialist can guide you.

It seems to me Penny is now a Special Needs Cat, if she needs that little bit of help eliminating, even if it's not all the time, but helping her twice a day even if she doesn't seem to need it could help keep her comfortable and reduce leaks.

As for crystals, do read up more about this and make up your own mind: a cat's urine is supposed to be quite concentrated and acidic to kill the bacteria that cause UTIs and whose waste products cause crystals. So too much fluid may not be the good thing it has always been assumed to be. Yes they need fluid intake but the issue is much more complex than pumping as much fluid into them as we possibly can. You say 6.5? Normal is 6.3 to 6.6 so if your vet is telling you 6.5 is wrong, get a new vet!

[Ruth B]

I have to agree with the others, the original cause is likely from the RTA injury, I've heard of several cats in RTAs that end up in rescue and the biggest question is always whether they will be able to eliminate waste by themselves afterwards. The attitude is always that bones can mend, legs can be amputated if there is no other option, but if the cat can't pee or poop by itself then there is likely nerve damage and that is one thing we still struggle to heal. So, while no expert, it does sound like Penny has suffered some nerve damage which has effected her ability to eliminate waste, and she is one lucky girl to have you there willing to help her.

At the moment it does sound like you and your vet are just dealing with the problems when they occur, it might be better to ask to be referred to a specialist so you can look at the problem as a chronic one and have it treated as such rather than treating each episode individually. It might be that there is medication that Penny could be put on long term to help prevent the episodes happening or at least reduce their frequency. My own old cat (now 19) developed bladder problems and Cystitis last year, she is now on medication to help that. After she was on it for a few months, with the agreement of the vet she was taken off it for a few days and I soon could see her starting to deteriorate so she went back onto it, and she will likely be on it for the rest of her life 1 to 2 tablets a day (the vet agreed that it was better for her to miss a dose now and then rather than stress her trying to give her them the hard way). I also want to ask, you mention she is a shy cat and the others can stress her out, does her attitude change at all after she has had an episode and then been on the pain medication for a while. If she is feeling uncomfortable it might make her not want to interact with them, if her attitude changes at the end of her medication run then it might mean she would be better off on some long term pain meds. In a case like this you have to treat it as palliative care, there is no cure, so what you do has to be to try and ensure that her life is as good as it can be, which you already seem to be trying to do.

I'll also mention the other thing that comes to mind. You say she has difficulty with her back legs, what style of litter tray and what litter are you using, if she is struggling to get in and out of a tray then a very shallow one might help her, and while a fan of clumping litter myself, it might be she would find a different type of litter easier to walk over. The final option might be something like puppy pads that she can just walk on and lie on to go, just knowing that there is somewhere she can go that isn't hard for her to get to might be enough to alleviate a little of her stress which can only be a good thing.

Finally, I want to say a thank you for looking after her. Any special needs cat is hard work, and one that has constant problems peeing and pooping is perhaps the hardest, and you have stood by her throughout doing the best you can for her. We aren't experts here, but we do understand what our cats mean to us and the challenges they can bring. We may have some experience or ideas that might help, and if nothing else we are always willing to offer support where we can. Sometimes just having someone to talk to, even if it is just text chat, can help relieve your own stress levels, and believe me as a cat owner they can build up when things aren't going as well as you want them to, and of course if you are stressed then your cat picks up on it, which just makes matters worse.

[macka]

Hello all, I want to thank you all for your kind words and support, and I also want to thank you for such lengthy replies. I really appreciate it. <3

I am going to address the things that have been mentioned one by one slowly, but a quick update on Penny: one of her other tests (biochemical profile, we did that with the blood panel but had to wait longer for results) came back from the vet clinic and the vet said in an email how her kidney enzymes are good but her liver enzymes are bit high and also her proteins are way higher. We also had a call with them on the phone today where they went a bit more in depth about the results but I can't remember the specifics exactly, but Penny is going back to the vet for the next 5 days to get IV fluids administered for 2 hours, and then we are gonna repeat her biochemical profile. I'm also gonna get a copy of her tests printed out as well.

I wonder if it is time to seek referral to a specialist - perhaps neurological as well as genitourinary. If the nerves governing her bladder control are damaged, which sounds probable from what you describe, that could explain her intermittent control and that in turn could help to explain the crystals and other issues. If the underlying cause is nerve damage and the accident was so long ago that it is unlikely that her nerve function will improve further at this stage, then it is down to getting the very best management routine in place that you can. I would be looking to review diet, fluids, drugs, supplements, frequency of manually helping her to void urine and faeces, etc with a specialist. Just increasing the amount of water she drinks by offering her the unsalted water chicken has been cooked in, or installing a fountain, might help a little with the crystals, although check with your vet first, of course.

I agree with this. I do want to see a neurologist for her condition and do non-invasive tests if possible, just to confirm if something is there or just to see how to handle her condition as best as possible when it comes to pain and such. I am also in the very slow process of talking with my current vet about supplements like pain meds or even cbd oil or anti depressants to help with her pain and/or stress levels etc., but the vet said that they would rather first focus on her current condition, work on that and then afterwards administer something for stress or pain. I hope that makes sense. When it comes to seeing a specialist about her other stuff- I will have to do bit of googling about that since there aren't proper veterinary hospitals in my country, only private vet clinics and several specialty clinic within the veterinary faculty/university. But me and my sister are also not opposed to travel outside of our town if necessary, as long as Penny gets 100% medical care she needs.

At the moment it does sound like you and your vet are just dealing with the problems when they occur, it might be better to ask to be referred to a specialist so you can look at the problem as a chronic one and have it treated as such rather than treating each episode individually. It might be that there is medication that Penny could be put on long term to help prevent the episodes happening or at least reduce their frequency.

I would honestly love this (to see a specialist). Because this is what we have been doing pretty much. And both me and my sister are getting a bit frustrated, because surely there is something more that can be done? Like, for example, making sure she gets pain medication or something else that would just help stress levels and mood management etc. It just feels like we are hitting a wall with her because by obvious standards (ie. have more than one litter, feed cats separately, keep them separate if one of them is stressed easily, have feliway, etc) we are doing everything. And we have mentioned this to the vet, but the vets haven't really referred us elsewhere, even when we asked about exploring further mentioning like "we don't care how much it costs, we just want to help our cat". So now I have taken myself to google and asking places on what to do or if anyone has had any experience with this because Penny does feel like such a special case. And when she is in her good moods, she is like the gentlest sweetest cat ever and she just radiates sunshine. So I would really hate seeing her even in any minor pain if it can be dealt with/prevented due to her nerves.

I also want to ask, you mention she is a shy cat and the others can stress her out, does her attitude change at all after she has had an episode and then been on the pain medication for a while. If she is feeling uncomfortable it might make her not want to interact with them, if her attitude changes at the end of her medication run then it might mean she would be better off on some long term pain meds.

I can't say much because for a few months now, she's mostly been hanging out with my sister in her room, where she has been away from the other 2 cats. But on the occasion she wants to explore outside my sister's room, we do let her out but we also keep the other 2 cats at bay. But for most part, she seems content in my sister room and is mostly sleeping. But that could also be currently due to her current painful condition since it is back again.

When one cat (Pippin) attacks her, he only attacks her when he is hungry/wants food (and he does get food! that cat is a giant pain in the butt when it comes to food! he is a huge foodie where I can feed him and he eats everything and then an hour later if he hears me rummaging in the kitchen he comes running and twirling around my legs for more food ). If Penny isn't present (like she hasn't been since she's mostly in my sister's room), he will either go attack my other cat Soot, but Soot can hold her ground and fights him off, although he will also go and chew on my plants (he doesn't touch them otherwise and I don't have any toxic ones as far as I'm aware) because he knows he gets in trouble so it's him doing it for attention.

But anyway, when Penny is attacked by Pippin, she doesn't fight back, she's just there and sort of takes it so every time I would even see him just going for her, I would immediately intervene. But after that, she psychologically recovers/bounces back pretty fast and continues on normal. But when Soot attacks her, it's like psychological warfare. She struggles more afterwards in her demeanor and doesn't feel comfortable. You can see that because of Soot's attacks, she is insecure in herself when it comes to exploring/walking around the apartment. It's like Soot doesn't like her because she's female (Soot is also female, also all my cats have been spayed/neutered years ago now). But it's also weird, because Soot doesn't attack all the time, only some of the times? And there were rare occasions where Soot would even approach Penny normally and sniff her and walk away. And if Penny is sleeping already somewhere, and Soot comes along (not to attack her, just to also sleep on the bed somewhere), Penny will start hissing and act uncomfortable, and then slightly go back to normal. And they will both sleep together on the bed, even if they are less than a meter apart.

When it comes to pain meds, we haven't been given any for home use yet. She's only gotten them during vet visits as immediate relief from her condition and that is it.

What style of litter tray and what litter are you using, if she is struggling to get in and out of a tray then a very shallow one might help her, and while a fan of clumping litter myself, it might be she would find a different type of litter easier to walk over. The final option might be something like puppy pads that she can just walk on and lie on to go, just knowing that there is somewhere she can go that isn't hard for her to get to might be enough to alleviate a little of her stress which can only be a good thing.

We do have 2 litter trays for her that are very shallow. And we have used puppy training pads before and she would use those. Sometimes instead of puppy pads we would also use old bathroom towels, just something soft for her and that absorbs. But we also switched one of her shallow trays to cat litter because there have been like 1-2 rare occurrences where she has gone into one other litters to pee? And she would also sometimes dig earth/dirt out from pots and then pee on that. So we thought..okay let's try with cat litter again, maybe should would prefer something more tactile as opposed to a puppy pad or a towel. We are currently using "Greenwoods Plant Fibre Natural Clumping Litter", but we might also try a clay litter, just to see which one she would prefer if any. And if not, back to puppy pads it is then.

A neurology opinion sounds like a good plan to me.

I know there are a million differences between us and cats because of our bipedal stance just for starters, but I do have nerve damage in the same area and I can tell you from experience a little inflammation caused by something as small as a false move can make you unable to pee and that is quite distressing when it happens. The nerves responsible for enabling elimination come from a different vertebral joint to the nerves controlling motor function in the legs. What can happen in road accidents is the tail can be trapped momentarily as the cat is running away, resulting in a sharp pull on the tail which can damage the spine and spinal cord.

With the expensive scans you would have to ask a neurologist about the options for care - put it bluntly, sometimes there is no sense in expensive diagnostic tests if they don't change the treatment options. On the other hand physio and even hydrotherapy can really help, so only the specialist can guide you.

It seems to me Penny is now a Special Needs Cat, if she needs that little bit of help eliminating, even if it's not all the time, but helping her twice a day even if she doesn't seem to need it could help keep her comfortable and reduce leaks.

As for crystals, do read up more about this and make up your own mind: a cat's urine is supposed to be quite concentrated and acidic to kill the bacteria that cause UTIs and whose waste products cause crystals. So too much fluid may not be the good thing it has always been assumed to be. Yes they need fluid intake but the issue is much more complex than pumping as much fluid into them as we possibly can. You say 6.5? Normal is 6.3 to 6.6 so if your vet is telling you 6.5 is wrong, get a new vet!

I'm really sorry to hear about your nerve damage, that is so hard and annoying to deal with. But I also want to thank you for sharing your experience, because yes, I also understand there is difference between cats and humans but I also believe if humans can feel the slightest of pain from whatever, then surely so can cats (and other animals/pets as well)! This just reaffirms my desire to take her to a neurologist and see what's up with her. I understand testing can also be a waste of time and money, but I love her so much, I feel like I at least should try. Or if anything, to come up for a proper treatment plan for her instead of going back and forth to the vet like so far.

And yes, the vet did tell us that her urine is completely normal actually! I think I'm just in such a frenzy from everything that I keep mentioning anything that might be relevant to the post lol. I'm mostly just concerned about the amount of leukocytes present in her urine because that definitely slightly feels abnormal, you know?

Anyway, thank you all so much again for your posts and I will keep you all updated. And also sorry for the long post myself. x)