Hi all, I am happy to have found this place and am hoping that someone might be able to offer some insight about my sick kitty. After finding blood in her urine on 12/23/03, I took her immediately to the vet and they kept her for several days. The x-ray shows that she has bladder stones, and the vet told me she believes they are calcium oxalate stones due to her extremely high acidic urine content.
Rather than doing surgery, the vet gave me a 30 day supply of Elavil (10mg) and said to give her one a day with the option of cutting her down to half doses if it affects her too badly. Elavil is normally used as an anti-anxiety medication, but the vet said that in this case, that particular medication would help to serve as an anti-inflammatory and might help relax her belly so she might pass the stones. They plan to do another x-ray in 30 days to see if she needs surgery.
The problem is, that medication has made her extremely sick only after two days. She has bled all over the place and has been throwing up tonight. Her appetite is gone and she's not drinking water. She seems so very miserable and it's painful to see her suffer so much. I'm tempted to request that they go ahead and so the surgery, but I know that will be traumatic for her too.
She was a stray when I found her and I'm guessing that she is about 5 years old. The vet put her on the "S/O diet" to control the ph in her urine, and did not put her on a diet specifically for calcium oxalate stones because they're not sure if that is the actual problem.
Any insight and / or advice is much appreciated.
Thank you,
Critter1 (mother of 5 kitties and 3 doggies)
My sick kitty...
Was a complete urinalysis done, and were oxalates identified in the urine sediment?Critter1 wrote:The x-ray shows that she has bladder stones, and the vet told me she believes they are calcium oxalate stones due to her extremely high acidic urine content.
First, call and ask your vet about using phenoxybenzamine, this is a more common approach in some cases where smooth muscle relaxation is warranted. (however, if kitty has a heart condition, this medication may be contraindicated, your vet can discuss this with you further)Critter1 wrote:The problem is, that medication has made her extremely sick only after two days. She has bled all over the place and has been throwing up tonight. Her appetite is gone and she's not drinking water. She seems so very miserable and it's painful to see her suffer so much. I'm tempted to request that they go ahead and so the surgery, but I know that will be traumatic for her too.
Where is she bleeding from, the bladder or elsewhere? If you feel the medication is making her sick and is not producing favorable effects, it's time to cease it and try a different med. Don't cease it though without first consulting your vet.
She needs to remain hydrated, so try tempting her by using bottled or filtered water (at room temp), add tuna juice to her water, put an icecube in it to entice her, whatever you can do to ensure she is drinking. If she is vomiting, she is probably dehydrated, you can't risk this with crystals or bladder/UTI. As for the bleeding, if it is frank red blood, an unusual amount in her urine, and if it is excessive, don't wait on this, call your vet or ER vet promptly and express your concern. You need to ensure this is not bleeding from some other source (i.e., a stone causing damage to the bladder wall or urethra, other causes of hematuria). Also, if your vet never prescribed antibiotics, now is the time to talk to him about them, the antibiotics can help reduce hematuria to some extent and will help target any bacterial infection.
If you're not comfortable with your current vet's approach, seek another one immediately. Concerning is the bleeding and not knowing for sure the source...equally concerning is her reduction in appetite and water consumption, this may or may NOT be associated with the crystals, you want to be sure other causes are ruled out ASAP.
..........Traci
Re: My sick kitty...
Thank you, Traci.
Yes, they did a urinalysis but were still unable to determine whether she has calcium oxalate or struvite stones. I'm convinced that the Elavil is the devil... she is pretty much in a catatonic state. The last two nights I have given her a full pill. Tonight I would like to skip the pill completely (not even give her a 1/2 dose), and call my vet first thing in the am... but I will give her the 1/2 dose if you think I should. She just seems lifeless right now. I've had to wash her feces and blood off of her body because she was too weak to clean herself.
She has not eaten a bite today. I have tried both the tuna juice in the water and the ice cube in the water and she is not responsive to either. Her mouth is very dry, and I've been trying to rub water on her gums with my finger to encourage her to drink.
The blood is coming from her bladder (I think) because it's in her urine. There is alot of blood. The vet said that there was no sign of bacteria (probably due to the high acidic level) so she didn't give her any antibiotics.
I know that surgery to remove the stones will be very expensive (especially since I just spent $240 for her last visit) but I'm starting to think it would be a better alternative to her suffering this way. Traci, do you think I should even fool with trying a different medication or just ask them to go ahead and do the surgery?
Thank you for your help. It's nice to have somewhere to talk about my concerns. I think I'll be around here for a long time.
Yes, they did a urinalysis but were still unable to determine whether she has calcium oxalate or struvite stones. I'm convinced that the Elavil is the devil... she is pretty much in a catatonic state. The last two nights I have given her a full pill. Tonight I would like to skip the pill completely (not even give her a 1/2 dose), and call my vet first thing in the am... but I will give her the 1/2 dose if you think I should. She just seems lifeless right now. I've had to wash her feces and blood off of her body because she was too weak to clean herself.
She has not eaten a bite today. I have tried both the tuna juice in the water and the ice cube in the water and she is not responsive to either. Her mouth is very dry, and I've been trying to rub water on her gums with my finger to encourage her to drink.
The blood is coming from her bladder (I think) because it's in her urine. There is alot of blood. The vet said that there was no sign of bacteria (probably due to the high acidic level) so she didn't give her any antibiotics.
I know that surgery to remove the stones will be very expensive (especially since I just spent $240 for her last visit) but I'm starting to think it would be a better alternative to her suffering this way. Traci, do you think I should even fool with trying a different medication or just ask them to go ahead and do the surgery?
Thank you for your help. It's nice to have somewhere to talk about my concerns. I think I'll be around here for a long time.
Re: My sick kitty...
Actually, if this were my kitty and I felt the elavil had anything to do with her current signs, I would do as you wish, cease it and call your vet first thing (no, don't give tonite's dosage, but do watch her carefully tonite and until you can get in contact with your vet). Since you've also described her acting somewhat lethargic, this would probably be noted with elavil, it can leave sedative-like effects, cause drowsiness, dry mouth and rapid heart rate. For this reason, your vet should either 1) decrease the dose significantly, or 2) withdraw it altogether and opt for something else, like phenoxybenzamine.
As for proceeding with surgery, I would advise a second opinion before opting for any surgical procedure, but time IS of the essense here. I don't know what level of experience your vet is capable of, but since he has yet to confirm whether or not these are oxalates, I would not procede with surgery until you knew for sure they were oxalates and/or were problematic, in that, they were large in number and size and creating problems specifically with scarring and/or hematuria, or were predicted to be undissolvable through a dietary and medical approach. Sometimes more than one urinalysis is warranted so the vet can make an accurate determination on the type of crystals involved (i.e., as opposed to struvites, which are easier to manage). If he couldn't reasonably conclude oxalates soley on urinalysis and x-rays alone, another sediment exam might be useful here. (or another vet altogether, more experienced in finding and identifying oxalates)
Now, the blood. I'm truly concerned here because I can't accurately gauge how much or to what consistency it is. If you can, try to feel the blood with your fiinger, if it feels gritty in the least (as opposed to just watery, like normal urine), ....then I must caution you this could be residual grit and/or minute crystals trying to pass through the urethra and she could be having some trouble. If you can determine that she is actually urinating normally, as in normal frequency, this may not be a veterinary emergency just yet, but if you DO feel any gritty substance from that blood whatsoever, combined with her inability to produce a normal amount of urine, I would strongly suggest you get her seen ASAP (on the offchance she could be trying to pass a crystal and it is lodged in the urethra, causing a blockage). If the blood seems heavy in volume (again, as opposed to normal watery urine), this could be an unassociated cause of hematuria, in which you want to have peace of mind it's not something else going on. I don't wish to alarm you, but when we're not able to accurately determine the consistency, color, volume, etc of blood, it's always best to consult with your vet when you're concerned.
As for her appetite and drinking.... It sounds like you may have to force-feed water with a syringe until you can speak with your vet. While this may be a side effect of the elavil, you don't want to risk her being severely dehydrated. Same for food, feed canned only, or even baby food (without onion or onion salt please, onion is toxic to cats). If she hasn't eaten in over 24 hours, try to force-feed with a syringe a few cc's every few hours until you make contact with your vet. Try blenderizing canned food with water and slowly feed with a syringe, so at least she will be getting some nutritional support. Note: if she is having trouble producing urine, or tiny drops at a time, straining, etc, don't give her water, contact an ER vet immediately for further instruction.
Again, despite the elavil's side effects, if you feel she isn't producing enough urine, or is straining in the litterbox, or any other signs that could indicate a blockage or severe irritation, has not eaten/drank anything in over 24 hours, is feverish or withdrawing and seeking to hide, is painful in the abdomen in the least, do not hesitate to contact an ER vet immediately. On the offchance you feel she might be severely reacting to the elavil, call an ER vet anyway, and ask them if they've seen kitties react this way like yours has. In my opinion, and based only on your post, the dose may be too high for her, or she could be suffering a reaction to it, best to talk with a vet promptly about that.
As for proceeding with surgery, I would advise a second opinion before opting for any surgical procedure, but time IS of the essense here. I don't know what level of experience your vet is capable of, but since he has yet to confirm whether or not these are oxalates, I would not procede with surgery until you knew for sure they were oxalates and/or were problematic, in that, they were large in number and size and creating problems specifically with scarring and/or hematuria, or were predicted to be undissolvable through a dietary and medical approach. Sometimes more than one urinalysis is warranted so the vet can make an accurate determination on the type of crystals involved (i.e., as opposed to struvites, which are easier to manage). If he couldn't reasonably conclude oxalates soley on urinalysis and x-rays alone, another sediment exam might be useful here. (or another vet altogether, more experienced in finding and identifying oxalates)
Now, the blood. I'm truly concerned here because I can't accurately gauge how much or to what consistency it is. If you can, try to feel the blood with your fiinger, if it feels gritty in the least (as opposed to just watery, like normal urine), ....then I must caution you this could be residual grit and/or minute crystals trying to pass through the urethra and she could be having some trouble. If you can determine that she is actually urinating normally, as in normal frequency, this may not be a veterinary emergency just yet, but if you DO feel any gritty substance from that blood whatsoever, combined with her inability to produce a normal amount of urine, I would strongly suggest you get her seen ASAP (on the offchance she could be trying to pass a crystal and it is lodged in the urethra, causing a blockage). If the blood seems heavy in volume (again, as opposed to normal watery urine), this could be an unassociated cause of hematuria, in which you want to have peace of mind it's not something else going on. I don't wish to alarm you, but when we're not able to accurately determine the consistency, color, volume, etc of blood, it's always best to consult with your vet when you're concerned.
As for her appetite and drinking.... It sounds like you may have to force-feed water with a syringe until you can speak with your vet. While this may be a side effect of the elavil, you don't want to risk her being severely dehydrated. Same for food, feed canned only, or even baby food (without onion or onion salt please, onion is toxic to cats). If she hasn't eaten in over 24 hours, try to force-feed with a syringe a few cc's every few hours until you make contact with your vet. Try blenderizing canned food with water and slowly feed with a syringe, so at least she will be getting some nutritional support. Note: if she is having trouble producing urine, or tiny drops at a time, straining, etc, don't give her water, contact an ER vet immediately for further instruction.
Again, despite the elavil's side effects, if you feel she isn't producing enough urine, or is straining in the litterbox, or any other signs that could indicate a blockage or severe irritation, has not eaten/drank anything in over 24 hours, is feverish or withdrawing and seeking to hide, is painful in the abdomen in the least, do not hesitate to contact an ER vet immediately. On the offchance you feel she might be severely reacting to the elavil, call an ER vet anyway, and ask them if they've seen kitties react this way like yours has. In my opinion, and based only on your post, the dose may be too high for her, or she could be suffering a reaction to it, best to talk with a vet promptly about that.
..........Traci
Re: My sick kitty...
Traci,
I really do appreciate you taking the time to respond... your advice has been very valuable. Thank you.
I have decided not to give her another Elavil pill tonight. She almost seems to be coming out of her lethargic state because she got up to drink some water, but then couldn't hold her head up any longer and almost fell asleep with her head resting on her water bowl. I soaked some of her food in water and then used a syringe to feed her the water that her food had soaked in. She drank quite a bit when I fed it to her that way. Wow... I wouldn't have thought about that. I know it's not as good as her actually eating, but I'll keep working on that tonight.
The blood that she is passing looks very mucous-y and thick. I got a good look at it this morning on my kitchen floor (I should have saved it somehow). It looked gritty, but I don't know that for sure.
I am planning to take her back to the vet in the morning and will ask about changing her to the phenoxybenzamine. I'll keep you posted on her progress. Thank you again!!
Shannon
I really do appreciate you taking the time to respond... your advice has been very valuable. Thank you.
I have decided not to give her another Elavil pill tonight. She almost seems to be coming out of her lethargic state because she got up to drink some water, but then couldn't hold her head up any longer and almost fell asleep with her head resting on her water bowl. I soaked some of her food in water and then used a syringe to feed her the water that her food had soaked in. She drank quite a bit when I fed it to her that way. Wow... I wouldn't have thought about that. I know it's not as good as her actually eating, but I'll keep working on that tonight.
The blood that she is passing looks very mucous-y and thick. I got a good look at it this morning on my kitchen floor (I should have saved it somehow). It looked gritty, but I don't know that for sure.
I am planning to take her back to the vet in the morning and will ask about changing her to the phenoxybenzamine. I'll keep you posted on her progress. Thank you again!!
Shannon
Re: My sick kitty...
Shannon, I'm glad to hear you'll be taking her to your vet in the morning....always best to play it safe.
I would strongly suggest a chem profile done for your kitty at that time, combined with another urinalysis. And again, not to alarm you, but laying down and head hanging over the water dish is not a good sign, this may be a sign of diabetes, if your vet never performed bloodwork during the initial urinalysis and stone findings, you want to get that done ASAP. One thing you can do temporarily to see if she will perk up is to rub a small amount of Light Karo corn syrup on her gums.....if she responds almost immediately and seems to get a quick burst of energy, she could in fact be suffering from a hypoglycemic episode as a result of diabetes. It is terribly difficult to advise here but your posts are so concerning and I want you to be cautious and watch her like a hawk tonite. If she seems like she's "crashing" in the least, call the nearest ER vet immediately, better to play this safe, not knowing exactly why she is exhibiting these symptoms so suddenly, and not knowing if it can in fact be attributed to the elavil.
The mucous might be mucous plugs, they can be a common occurance in frequent urinary tract infections, and when hematuria is present. They are usually small drops of mucous in the blood from the urine, but if they seem larger than just a drop....it's time to get her evaluated ASAP.
I would strongly suggest a chem profile done for your kitty at that time, combined with another urinalysis. And again, not to alarm you, but laying down and head hanging over the water dish is not a good sign, this may be a sign of diabetes, if your vet never performed bloodwork during the initial urinalysis and stone findings, you want to get that done ASAP. One thing you can do temporarily to see if she will perk up is to rub a small amount of Light Karo corn syrup on her gums.....if she responds almost immediately and seems to get a quick burst of energy, she could in fact be suffering from a hypoglycemic episode as a result of diabetes. It is terribly difficult to advise here but your posts are so concerning and I want you to be cautious and watch her like a hawk tonite. If she seems like she's "crashing" in the least, call the nearest ER vet immediately, better to play this safe, not knowing exactly why she is exhibiting these symptoms so suddenly, and not knowing if it can in fact be attributed to the elavil.
The mucous might be mucous plugs, they can be a common occurance in frequent urinary tract infections, and when hematuria is present. They are usually small drops of mucous in the blood from the urine, but if they seem larger than just a drop....it's time to get her evaluated ASAP.
..........Traci
Re: My sick kitty...
Shannon,
I'm thinking about you and your kitty. When you get a chance, please update, okay...
Bests
I'm thinking about you and your kitty. When you get a chance, please update, okay...
Bests
Lisa, Angel Smokey and little Caz
Re: My sick kitty...
Hi all, thanks again for helping last night and keeping my little girl (Kendall) in your thoughts. After getting about an hours worth of sleep last night, I took her in to her vet first thing this morning. As if my luck couldn't get any worse, on the drive to the vet, I witnessed the car in front of me run over a kitty that was crossing the road (no, they did not stop to help). It felt like a bad dream. I immediately pulled over and stopped traffic and gently wrapped the kitty in my coat and put her in my backseat and rushed to the vet. She didn't make it, so needless to say I was pretty grief-stricken when I actually got Kendall in and was able to talk to the vet about her condition over the weekend.
I let them know everything that I could remember about her symptoms and they decided to keep her today to observe and give her fluids. I stopped back by this evening and they said that she was alert, but still had not urinated but that she continued to lose a significant amount of blood, so they would keep her overnight. The doctor did say that she strongly believes that her condition last night was a result of the elavil and not related to a different medical condition (Traci, I did ask about diabetes and additional testing.) The doc also stated that the sediment that they collected during the urinalysis was not enough to determine whether the she actually does have the calcium oxalate or struvite stones (two doctors from the clinic have told me that.)
So in a nutshell, I have no clue what tomorrow will hold for her. I'm just so thankful that she is not on the elavil any longer and is in a safe place (even though I hate that she isn't home.)
Again, I am grateful for all your words of advice and comfort. I'll keep you all posted.
Shannon
I let them know everything that I could remember about her symptoms and they decided to keep her today to observe and give her fluids. I stopped back by this evening and they said that she was alert, but still had not urinated but that she continued to lose a significant amount of blood, so they would keep her overnight. The doctor did say that she strongly believes that her condition last night was a result of the elavil and not related to a different medical condition (Traci, I did ask about diabetes and additional testing.) The doc also stated that the sediment that they collected during the urinalysis was not enough to determine whether the she actually does have the calcium oxalate or struvite stones (two doctors from the clinic have told me that.)
So in a nutshell, I have no clue what tomorrow will hold for her. I'm just so thankful that she is not on the elavil any longer and is in a safe place (even though I hate that she isn't home.)
Again, I am grateful for all your words of advice and comfort. I'll keep you all posted.
Shannon
Re: My sick kitty...
Oh yes, I forgot to say that Kendall didn't throw up any today (good news), and she seemed much more alert and oriented (seemed like the elavil was wearing off). They put her on Pepcid AC (I didn't know they put cats on pepcid) for her stomach, gave her an apetite stimulant and also gave her something else but I have no clue what the last thing was (it's been a long day.) 
Re: My sick kitty...
Shannon, thanks so much for the update on Kendall, I have been worried for you two....I'm glad to hear she is being observed and I so hope your vet can get to the root of the problem. Please do keep us updated as you know more.
Bless your heart for coming to the other kitty's aid....because of you, she knew love and compassion before she passed on.....thank you for caring so much.
Bless your heart for coming to the other kitty's aid....because of you, she knew love and compassion before she passed on.....thank you for caring so much.
..........Traci