Cat Gang - crystal prevention

[beowulf]

Hello COTH, your certified cat (and plant) lady has questions.

I have a 2 y/o female/spayed kitty that has presented 3 times now with what we thought were UTIs. We treated with ABX. Her symptoms were frequent litter box use, and light blood in urine. On Thursday morning she presented with these symptoms again – I brought her to the vet, and pushed for more diagnostics. Tentatively treated as UTI pending urology report, ultrasound of her bladder was non-conclusive. After urology report (Fri AM) and ultrasound, vet said she has urine crystals and prescribed Prazosin, discontinued the ABX because there was no bacteria in her urine. As of this AM, kitty is still urinating frequently and seems uncomfortable.

Two questions for the Cat Horde:
One - how long does Prazosin take to help? I’ll be asking the vet’s office this, but they aren’t open yet.
Two - The vets suggested she go on prescription cat food for the crystals. The two they suggested were Royal Canin U/R or Purina Pro Plan U/R. Both are $85-100 for a 15lb bag Are there any better alternatives out there, or supplements even? I’m not a fan of either brand.

I already have one cat on Prescription Food. The non-script kitties get grain free dry food (Instinct or Vet+, I rotate) AM, Weruva wet food PM. Neither are necessarily low quality cat foods. So, three questions actually – is diet contributing to this, or am I looking at something else?

A fourth question - feeding four different kinds of cat food is going to be a logistical nightmare. Anyone have any tips/suggestions for streamlining this? Including storage in a small house?

Side note - a shout out to Litter Robots, because I’ve caught this thing early all three times due to being able to see increased usage via the LR app.

Would appreciate any suggestions or help.

EDIT @ 9:30 AM: Called vet, they are seeing her tonight at 5 PM and agree medication should have kicked in by now.

[JB]

Cats really, really need to be on canned food. They aren’t good drinkers, as historically they rely on blood and moisture from the creatures they eat, for their water. And, dehydration is one cause of these forming. So, that’s one change that may be all she needs to not get them again.

Otherwise, it’s often high magnesium or high phosphorous, which means a Rx diet, but I’d definitely go the canned route first

[Simkie]

@beowulf

I already have one cat on Prescription Food. The non-script kitties get grain free dry food (Instinct or Vet+, I rotate) AM, Weruva wet food PM. Neither are necessarily low quality cat foods. So, three questions actually – is diet contributing to this, or am I looking at something else?

A fourth question - feeding four different kinds of cat food is going to be a logistical nightmare. Anyone have any tips/suggestions for streamlining this? Including storage in a small house?

Excess vitamin D (as in recall levels) can cause calcium oxalate stones, so it’s a good box to check to look through the various recall lists if that’s what you’ve got, just in case. Ironically, Royal Canin prescription food with excess vitamin D is what caused my cat’s stones, years ago. Yeah, I’ll never feed them again.

I crate my cats for meals and highly recommend it. Everyone gets what they’re supposed to get and any refusal or inappetence is very immediately obvious. I use 24" wire dog crates. Super easy to train. I know space is an issue! We stack ours two high for a smaller footprint.

[beowulf]

Are we thinking that the dry food being fed is a detriment to the wet food they’re already getting, and the crystals are a result of that? They get 1/4c dry in AM, and then about ~5 oz wet at night.

Both of the Rx foods suggested are dry. I didn’t ask about if there’s a wet food alternative. My vet specifically mentioned to keep feeding her the Weruva and to find an Rx dry. I can ask tonight.

I think training them to a crate would be easy enough, I have to figure out the space. They’re already trained to their specific “stations”.

I’ll check the GA on the cat foods about excess Vitamin D. I don’t really know much about that; is there a blood test I can ask for tonight?

Mo’ cats, mo’ problems. If it’s not cat vet bills, it’s horse vet bills.

[Simkie]

@beowulf

I’ll check the GA on the cat foods about excess Vitamin D. I don’t really know much about that; is there a blood test I can ask for tonight?

It’s not a GA issue–it’s an error in production, leading to a recall. If the stones are calcium oxalate (which are rarer than struvite) a vitamin D level might be a box to check. If that’s the type of stone you’re dealing with, starting with just thoroughly looking for recalls is reasonable.

From what I recall (it’s been quite a while!) struvite stones dissolve with diet change. Calcium oxalate do not. You can prevent more from forming. But identifying why they’re there is helpful.

I did find my cats overall health to really improve once I switched to 100% wet. Like you, I used to feed a mix of premium dry and wet. I know the cost of all wet is nauseating (esp since covid, good lord) but it does make a big difference.

[JB]

@beowulf

Are we thinking that the dry food being fed is a detriment to the wet food they’re already getting, and the crystals are a result of that? They get 1/4c dry in AM, and then about ~5 oz wet at night.

Very possible, yes. Probably not a problem for all cats, but some just seem a bit more sensitive to even milder dehydration. I would at least switch to all canned for now and see if any more crystals form. We had a run of struvite issues years ago, 1 female, 2 males, despite already eating a canned diet of reasonbly good quality food, so I switched to a DIY raw, and they stopped and never returned. The one exception so far has been a kitty we just lost, who started having some UTIs maybe 18 months ago BUT, it also turned out she had bladder cancer, and while the first UTI was tested and found to have bacteria. a couple of the last ones were very clean, and then one showed up with the “rafts” of shedding tumor cells She was 19 at the time, this was last Fall, and we just said goodbye to her 2 weeks ago as the cancer had progressed and was the likely cause of her fairly sudden CKD. But in the 10 or so years between, she never had another uti

[Xanthoria]

We had two of our four cats with crystals - male and female. Switched everyone to wet and dry Rx food. Still had problems. Switched to wet only Rx food (Purina UR) - problems seem to be resolved for female cat; male cat might have other issues but seems good.

Added a urine acidifier supp- not sure if it helps? Male cats urine was not acid before we started it. Female cat was prescribed Prozac but she hated having it applied to her ear so much that we had to quit.

[OzarksRider]

@Xanthoria

urine acidifier supp

I gave one of my cats Methigel to acidify his urine. It’s cheap and doesn’t require a prescription, so might be worth a try.

Also, is there anything at all that could be stressing the cat? Are other cats picking on her? Any unusual activity in the household? I once had a cat with chronic cystitis that definitely was caused by stress. He was the kind of cat that HAD to go outside, but I like my cats to be in at night. The poor guy was so stressed he was peeing blood. I started letting him out whenever he wanted to go and his cystitis cleared right up (but I always worried about him all night).

[JB]

@OzarksRider

Methigel

I was trying to remember what we used those years ago and yes ,the Methigel is great for helping with struvite crystals/stones. I think it’s contraindicated for oxalate though? But yes, for the OP, that’s a good option, and not sure why that wasn’t prescribed instead of just trying to relax the bladder/urethra.

[beowulf]

Thanks all. Our appointment got moved up to 4:30. Anything else sticking out that I should ask the vet about (besides whether a wet food Rx is available)? Should I push for more diagnostics? Ask about Methigel? They didn’t say anything about PH balance/acidity in the urine test. Her ultrasound came back inconclusive, it was the urology report that diagnosed the crystals.

As far as stress - I am not sure. She is a pretty jovial cat - and gets along with all the other cats in the house. Even if something was bothering her, she’s not the type of cat to complain.

[JB]

If it’s definitively struvite, then absolutely ask about the Methigel. You can ask about an Rx food, but not only are you right that they’re SO freaking expensive, you might find all you need to do is remove dry food and feed only wet. There are some raw dehydrated or frozen foods (that aren’t cheap either) which can be fed re-hydrated/soaked, and might potentially be cheaper than Rx, but also healthier than most of the canned foods. Even higher quality canned foods still have technically too many carbs. Grain-free is not the good thing it sounds like, because while yes they don’t add high-carb grains, they DO add high-carb vegetables.

Honestly, if you wanted to consider DIY raw food, I’m happy to talk to you about it. My formula from the catinfo.org site, designed by a vet with extensive research into this, and I can “dumb it down” for you in terms of what to do. I can make food for literally less than 1/10th the cost of commercial foods of decent quality, let alone the upper tiers where it can be $3/day to feed 1 cat.

[deweydee]

I’ll start by saying, I don’t have any experience with crystals in cats and I hope your vet visit goes well. The catinfo website is a real wealth of information!

We use the TC Feline mix she mentions and it’s a breeze. Between hunting, meats on sale, etc, it’s definitely been cheaper for us than premium wet food. Plus you’re avoiding many of the fillers in the cheaper wet foods. We meal prep a few pounds at a time and freeze them into portioned “pucks”, defrosting enough for a few days at a time.

[beowulf]

JB, I am so sorry to hear you lost your kitty. Big hugs.

I am going to PM you at some point, possibly later today once I’m done with work, just wanted to fire off a quick update.

At our most recent vet visit they re-affirmed it’s crystals. For now, I did order the Purina U/R

None of her symptoms have improved. It’s possible I am being unrealistic with how quickly symptoms from crystals should resolve. She is currently on 1 ml gaba 2x a day, Prazosin 2x a day, 1 Zkylene AM/PM, and is about to start on Prozac tonight - that got shipped to us via a compounding pharmacy.

My vet’s office didn’t give me any clear guideline on the timeline here, and I feel like the world’s biggest PITA because I’ve already called them three times for questions/clarifications - but there isn’t anything on the discharge paperwork for even how long these things should be fed - I’m assuming until the script[s] run out.

The vet feels strongly it is behavioral/anxiety over territory hence the Prozac. What surprises me is they haven’t prescribed anything for the dissolution of the crystals – well, besides the food. Is that normal?

[JB]

IME no, it’s not normal to not work to actively dissolve the crystals

Last week when our OTHER CKD kitty was in for a checkup, she brought her “show and tell”. They’d had a male kitty in for “issues” and during the exam he started peeing blood so they grabbed a pee tray. Once they finished with the sample, she let the tray dry. It’s like SANDPAPER with all the crystals in there, all that coming through the urethra

[foursocks]

Here is my input as someone who has worked in the pet food industry for about 20 years now, and has been doing research for my own pets into it for even longer than that, and has some experience with crystals in a dog. The Rx foods tend to be high in sodium to get them to drink more, and have not very good ingredients, neither of which is great for the animal. These foods are incredibly, stupidly over-priced for what you get–I would take a look at the ingredients and do a little research, as there are a lot of great resources out there. It’s the internets, so there is a lot of dumb stuff, too, but one can easily find educated and educational information to help you choose how to manage this particular issue.

There are some good canned food alternatives with much higher-quality ingredients and a much lower pricetag out now for various issues (Dave’s makes some as does My Perfect Pet and a few others), so you may want to look into that. Cats should be on wet or raw food as best practices because they do not tend to drink enough water on their own, as some have mentioned. Cats can obviously live a nice long life on kibble, but if possible they should be on wet food, and pretty much any cat with urinary issues is going to do best on wet food of some type.

We had a young dog who needed several hours of surgery to remove hundreds of struvite crystals, after which we followed a particular regimen for the rest of his life. We fed him raw food along with cranberry powder, B-vitamins, and stinging nettles (dried and powdered). He never had a recurrence of the crystals and we lost him to cancer as an older dog. We have fed all of our cats raw food for over 15 years now and we have never had any issues with crystals.

[beowulf]

@foursocks

There are some good canned food alternatives with much higher-quality ingredients and a much lower pricetag out now for various issues (Dave’s makes some as does My Perfect Pet and a few others), so you may want to look into that. Cats should be on wet or raw food as best practices because they do not tend to drink enough water on their own, as some have mentioned. Cats can obviously live a nice long life on kibble, but if possible they should be on wet food, and pretty much any cat with urinary issues is going to do best on wet food of some type.

I guess my quibble is my cats are on wet food – but it sounds like they need to be exclusively on wet food, no kibble period.

Does anyone know what specifically it is in the U/R St/OX that promotes crystal breakage, why can’t that be something fed as a supplement/top-dress? Believe me, I am not trying to get out of feeding what this cat needs, but at $100 for a sixteen pound bag that this cat needs to be on for the rest of her life, I’d rather find a supplement that can be added to wet food.

While I am not discounting the very valid point that cats need wet food, neither of the two vets have mentioned wet-food exclusivity - one was actually surprised when I asked for a rewrite of the script to wet-food.

Should I be involving a second opinion of a different vet…? I know small animal vets are different, but the more experience I have with them the more grateful I am for my horse vet. At this point I feel like she’s had all of these medications to address the symptoms but nothing to address the actual problem, which is the crystals.

[foursocks]

At the risk of getting yelled at, I would quietly mention that many vets get chunks of their nutrition education from the big pet food companies, and they certainly get extremely good deals on the Rx foods. We’ve had excellent vets over the years and they all sell the prescription diets. Our current vet sells them, but she is also quite knowledgeable about raw foods and nutrition in general, so I can talk to her about it. I put it down to the fact that she is also a horse person!

As for getting rid of the crystals, in my very limited understanding it depends on the type of crystals. I know that changing the pH and increasing water intake is sort of the basic approach, which is why we added cranberry powder to our dog’s food and made the whole thing very soupy. Honestly, you may want to google around and see what you find- again, there is a lot of crazy, but in this area there is some really useful info out there.

[JB]

@beowulf

Does anyone know what specifically it is in the U/R St/OX that promotes crystal breakage,

Methionine helps acidify the urine which is what helps break down and prevent struvites from forming. I’ve never looked at the U/R feeds but they might be higher in methionine. My vet has ALWAYS given Methigel for the active struvite issues we had

@beowulf

While I am not discounting the very valid point that cats need wet food, neither of the two vets have mentioned wet-food exclusivity - one was actually surprised when I asked for a rewrite of the script to wet-food.

General vets really aren’t up on nutrition for animals, unfortunately, not horses, not cats/dogs.

@foursocks

At the risk of getting yelled at, I would quietly mention that many vets get chunks of their nutrition education from the big pet food companies, and they certainly get extremely good deals on the Rx foods.

No yelling here, I’ve said this for years. I can’t fault them for their education on this, nutrition is just not a big focus of any general practitioner, and what little they do get, whether horses or small animals, tends to come from the big food companies.

[beowulf]

@JB

Methionine helps acidify the urine which is what helps break down and prevent struvites from forming. I’ve never looked at the U/R feeds but they might be higher in methionine. My vet has ALWAYS given Methigel for the active struvite issues we had

Forgive my ignorance here-- struvite stones are synonymous with crystals, then?

When they tested her urine, they did not mention what type of crystal. I did not think to ask, and unfortunately, none of her paperwork has anything about diagnosis.

I’ll probably be a PITA and call the office later for more info. I do feel in the dark here.

[Simkie]

@beowulf

Forgive my ignorance here-- struvite stones are synonymous with crystals, then?

No, unfortunately not. They do need to test the crystal to know if it’s calcium oxalate or struvite.

Hills used to have a prescription diet specifically for calcium oxalate crystals, separate from their struvite diet, because the different types required different dietary management.

Feline Struvite and Calcium Oxalate Urolithiasis

Although there are some things that suggest one or the other,

“Definitive diagnosis requires quantitative mineral analysis of uroliths that have been voided or recovered from the urinary tract.”