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New - Xena leaking urine. All tests show nothing. DESPERATE - pls help us.

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  • sound_of_seas
    Xena s background -- A few months ago Xena was urinating frequently, so the vet gave her 2 weeks Clavamox. She had an allergic reaction to it (itchy paws) and
    Message 1 of 4 , Jun 30, 2013
      Xena's background --
      A few months ago Xena was urinating frequently, so the vet gave her 2 weeks Clavamox. She had an allergic reaction to it (itchy paws) and was still urinating frequently so he gave her 2 weeks Baytril. Still urinating so another 3 weeks of Clavaseptin (same as Clavamox). By the end of the meds, she was in excruciating pain where she couldnt even walk straight. I could see pain in her back right leg. This could not be explained by the vet. With all the urination, she got dehydrated and constipated. The vet gave her lactulose. She had an awful reaction and was constantly leaking urine. Her stool was cleared out under general anesthetic. She now has BM once or twice daily with miralax, but leaks urine while sitting. Her vulva is sore and she pulsates/clenches it and squirts urine if touched while cleaning. She also shows a pink hue (blood) to the urine some of the time. Xena eats ONLY grain/veggie free canned food. All through this Xena's appetite has been good, and there has been no vomiting
      or diarrhea.

      -- Urinalysis two days after starting first round of antibiotics showed red and white blood cells. USG of 1.045. Urine pH 7.0
      -- Aerobic culture after the antibiotics were stopped was negative.
      -- Xrays showed no stones.
      -- Blood work showed kidneys and other organs in good shape.
      -- The neurological consult showed no deficiencies to cause leaking.
      -- Ultrasound showed nothing that would cause her urination. Her colon was not large (no megacolon) and there was not much stool present. The passage of urine is fine..no obstruction. Her bladder was quite full which she does not empty fully.
      -- Another typical (aerobic) and mycoplasam/ureaplasma cultures came back negative.

      So after all the tests (done at a vet university) we still have no answers. It seems that she may not be emptying her bladder because of inflammation or an infection in her urinary tract/bladder. Which antibiotic would you try next? Can you please give me your suggestions and insight? We are desperate and would hate to lose her due to an unresolved infection or another simple issue.
      Also, the skin on her lower abdomen has urine scalding and scabs. Can you please suggest what we can do for this?
      Thanks,
      Sue and Xena.
    • sound_of_seas
      Additional Info - Xena is a long haired, dilute calico, spayed, 6 year old, female cat. She has been seen by internal medicine specialists (faculty) at a
      Message 2 of 4 , Jul 1, 2013
        Additional Info -
        Xena is a long haired, dilute calico, spayed, 6 year old, female cat. She has been seen by internal medicine specialists (faculty) at a leading Veterinary College at a University.
        Thanks for your help,
        Sue and Xena.

        Here is the ultrasound report and neurological consult info -
        Abdominal ultrasound -
        The spleen is diffusely prominent being up to 8mm with normal echogenicity. At the tip of the left limb of the pancreas there is a focal, small, 8mm diameter, rounded nodule which is predominantly isoechoic to the remainder of pancreatic tissue but contains a few hypoechoic areas. This has well-defined margins which differentiate it from the more normal portion of the pancreas. In the spleen there are a few hyperechoic foci. In the liver there is a focal small area that contains multiple hypoechoic cysts this is up to 1.5cm in diameter. In a few other locations within the liver there are tiny hypoechoic cysts. The right kidney is mildly misshapen having a focal indentation in the caudal pole that is mildly hyperechoic.
        Conclusions -
        (1) Hepatic cystic nodules - most consistent with biliary cyst adenoma
        (2) Prominent spleen - most consistent with normal anatomic variation
        (3) Pancreatic nodule - differential diagnosis should include hyperplasia, fibrosis, or less likely neoplasia
        (4) Chronic infact, right kidney - incidental finding
        (5) Myelolipomas, spleen - incidental finding
        Discussion -
        There is no evidence of a mass. A cause of the reported inappropriate urination is not identified. Although the size of spleen is at the upper limit of expectation for cats, the echotexture is unremarkable and this is most likely due to anatomic variation

        Neurology consultation -
        Gait/Posture - Ambulates without assistance. Wide-based stance in pelvic limbs. No obvious ataxia. Low tail carriage. Postural reactions within normal limits.
        Spinal Reflexes - NAF including cutaneous trunci and perineal.
        Pain - Cries on tail jack and on caudal lumbar/lumbosacral palpation

        BLOOD TEST RESULTS -
        Biochemistry Profile --
        Calcium - 2.47 mmol/L (2.22-2.78)
        Phosphorus - 1.87 mmol/L (0.80-2.29)
        Magnesium - 1.1 mmol/L (0.80-1.10) HIGH
        Sodium - 155 mmol/L (147-166) High end of range
        Potassium - 4.5 mmol/L (3.6-5.2)
        Chloride - 115 mmol/L (114-123) Low end of range
        Carbon Dioxide - 18 mmol/L (14-21)
        Anion Gap - 27 mmol/L HIGH
        Na:K ratio - 34 (30-41) Low end of range
        Total Protein - 70 g/L (66-84)
        Albumin - 34 g/L (30-44) Low end of range
        Globulin - 36 g/L (27-48)
        A:G Ratio - 0.94 (0.7-1.4)
        Urea - 7.7 mmol/L (6.0-12.0) Good
        Creatinine - 88 umol/L (50-190) Good
        Glucose - 4.0 mmol/L (4.4-7.7) LOW (hadnt eaten much that morning)
        Cholestrol - 3.94 mmol/L (2.00-12.00)
        Total Bilirubin - 1 umol/L (0-3)
        Conjugated Bilirubin - 0 umol/L (0-1)
        Free Bilirubin - 1 umol/L (0-3)
        Alkaline Phosphate - 26 U/L (16-113) Low end of scale
        GGT - 0 U/L (0-6)
        ALT - 34 U/L (31-105)
        CK - 99 U/L (62-362)
        Amylase - 1381 U/L (482-1145) HIGH
        Lipase - 12 U/L (12-32)
        Calculated Osmo - 308 mmol/L

        Complete Blood Count --
        WBC - 14.6 (4.2-13.0) HIGH
        RBC - 6.6 (6.2-10.6) Low end of scale
        Hb - 126 g/L (93-153)
        HCT - 0.36 L/L (0.28-0.49)
        MCV - 55 fL (39-52) HIGH
        MCH - 19 pg (13-17) HIGH
        MCHC - 349 g/L (300-344) HIGH
        RDW - 14.2 % (14-17) Low end of scale
        Platelets - 532 (93-514) HIGH
        MPV - 12.1 fL (8-21)
        T.S. Protein - 80 g/L (60-80) High end of scale
        Seg Neutrophil Count - 12.41 (2.1-8.3) HIGH
        Band Neutrophil Count - 0.15 (0.0-0.3)
        Lymphocyte Count - 1.46 (1.1-8.1) Low end of scale
        Monocyte Count - 0.58 (0.0-0.5) HIGH
        Rouleaux - 1+
        Shift Platelets - 1+

        --- In CatVet@yahoogroups.com, "sound_of_seas" <sound_of_seas@...> wrote:
        >
        > Xena's background --
        > A few months ago Xena was urinating frequently, so the vet gave her 2 weeks Clavamox. She had an allergic reaction to it (itchy paws) and was still urinating frequently so he gave her 2 weeks Baytril. Still urinating so another 3 weeks of Clavaseptin (same as Clavamox). By the end of the meds, she was in excruciating pain where she couldnt even walk straight. I could see pain in her back right leg. This could not be explained by the vet. With all the urination, she got dehydrated and constipated. The vet gave her lactulose. She had an awful reaction and was constantly leaking urine. Her stool was cleared out under general anesthetic. She now has BM once or twice daily with miralax, but leaks urine while sitting. Her vulva is sore and she pulsates/clenches it and squirts urine if touched while cleaning. She also shows a pink hue (blood) to the urine some of the time. Xena eats ONLY grain/veggie free canned food. All through this Xena's appetite has been good, and there has been no vomiting
        > or diarrhea.
        >
        > -- Urinalysis two days after starting first round of antibiotics showed red and white blood cells. USG of 1.045. Urine pH 7.0
        > -- Aerobic culture after the antibiotics were stopped was negative.
        > -- Xrays showed no stones.
        > -- Blood work showed kidneys and other organs in good shape.
        > -- The neurological consult showed no deficiencies to cause leaking.
        > -- Ultrasound showed nothing that would cause her urination. Her colon was not large (no megacolon) and there was not much stool present. The passage of urine is fine..no obstruction. Her bladder was quite full which she does not empty fully.
        > -- Another typical (aerobic) and mycoplasam/ureaplasma cultures came back negative.
        >
        > So after all the tests (done at a vet university) we still have no answers. It seems that she may not be emptying her bladder because of inflammation or an infection in her urinary tract/bladder. Which antibiotic would you try next? Can you please give me your suggestions and insight? We are desperate and would hate to lose her due to an unresolved infection or another simple issue.
        > Also, the skin on her lower abdomen has urine scalding and scabs. Can you please suggest what we can do for this?
        > Thanks,
        > Sue and Xena.
        >
      • Sandy
        I wish I had some insight. One of the first thoughts I had was maybe bladder cancer and that is only because I have first hand experience with this rare
        Message 3 of 4 , Jul 1, 2013
          I wish I had some insight. One of the first thoughts I had was maybe bladder cancer and that is only because I have first hand experience with this rare disease or a kidney infection or a UTI or idiopathic cystitis and then I saw that you had an ultrasound done and all your bloodwork was normal. Have you had a regular culture and sensitivity done? Did a regular vet do the ultrasound or a specialist? It sounds like you are doing everything that you can. Maybe the next step would be to see an internist.
          Best of Luck Sandy

          --- In CatVet@yahoogroups.com, "sound_of_seas" <sound_of_seas@...> wrote:
          >
          > Xena's background --
          > A few months ago Xena was urinating frequently, so the vet gave her 2 weeks Clavamox. She had an allergic reaction to it (itchy paws) and was still urinating frequently so he gave her 2 weeks Baytril. Still urinating so another 3 weeks of Clavaseptin (same as Clavamox). By the end of the meds, she was in excruciating pain where she couldnt even walk straight. I could see pain in her back right leg. This could not be explained by the vet. With all the urination, she got dehydrated and constipated. The vet gave her lactulose. She had an awful reaction and was constantly leaking urine. Her stool was cleared out under general anesthetic. She now has BM once or twice daily with miralax, but leaks urine while sitting. Her vulva is sore and she pulsates/clenches it and squirts urine if touched while cleaning. She also shows a pink hue (blood) to the urine some of the time. Xena eats ONLY grain/veggie free canned food. All through this Xena's appetite has been good, and there has been no vomiting
          > or diarrhea.
          >
          > -- Urinalysis two days after starting first round of antibiotics showed red and white blood cells. USG of 1.045. Urine pH 7.0
          > -- Aerobic culture after the antibiotics were stopped was negative.
          > -- Xrays showed no stones.
          > -- Blood work showed kidneys and other organs in good shape.
          > -- The neurological consult showed no deficiencies to cause leaking.
          > -- Ultrasound showed nothing that would cause her urination. Her colon was not large (no megacolon) and there was not much stool present. The passage of urine is fine..no obstruction. Her bladder was quite full which she does not empty fully.
          > -- Another typical (aerobic) and mycoplasam/ureaplasma cultures came back negative.
          >
          > So after all the tests (done at a vet university) we still have no answers. It seems that she may not be emptying her bladder because of inflammation or an infection in her urinary tract/bladder. Which antibiotic would you try next? Can you please give me your suggestions and insight? We are desperate and would hate to lose her due to an unresolved infection or another simple issue.
          > Also, the skin on her lower abdomen has urine scalding and scabs. Can you please suggest what we can do for this?
          > Thanks,
          > Sue and Xena.
          >
        • CatWoman
          (you answered some of my questions in your second message but I only have time to approve it, will read it later. Meanwhile, wanted to post what I d written
          Message 4 of 4 , Jul 1, 2013
            (you answered some of my questions in your second message but I
            only have time to approve it, will read it later. Meanwhile,
            wanted to post what I'd written originally anyway).

            I would actually try prednisolone first - anti-inflammatory and will
            suppress any immune responses that may be involved.

            I'd also try Convenia, since you've tried the other antibiotics - there
            can be an infection that is not present in the urine.

            What kind of litter do you use? If you are using clumping she might be
            reacting to that - either the feel of it or having an alergic reaction
            (given that that area is affected). Also - if you're using one of the
            natural litters, she is getting grain (Swheat Scoop = wheat) or corn;
            or pine.

            You may want to switch to puppy pads or something for a while and see
            if that helps; or even old-fashioned clay litter (on top of a puppy pad
            so she can still scratch).

            Change the litter box - get a new one - there may be bacteria in the
            plastic. Maybe switch to an aluminum baking pan, or at least use one
            to line the box.

            Or try a Breeze box - it uses ceramic pellets and the urine goes through
            to a pad in a drawer below.

            Do have a fecal sample tested - there may be some bacteria or parasite
            that is causing problems.

            Get her to drink more water - and get distilled water so any mineral
            intolerance can be ruled out.

            Did the x-rays/ultrasound cover enough area to see if there is a tumor?
            And did the blood work look for something viral or something like a
            "real" leukemia, lymphoma, etc.?

            Try getting organic boneless, skinless chicken breast/thigh meat and
            cook lightly - baby food chicken is recommended as the 'bland diet' for
            cats, but all the ones I've seen these days have corn starch or some
            other thickener, so making your own - either bake lightly, microwave
            lightly, or stew gently in the distilled water - you know what is in
            the food. A few days of lower taurine won't hurt her, and you might
            find out if it's a food allergy (after the chicken, try turkey, then
            rabbit - Evangers makes a line of foods that has little to no non-meat
            ingredients. At one time I'd have suggested Evo but since they were
            sold to the Evil Empire, I don't even trust their 95% foods).

            dg
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