It's time to come clean.
After years of righteous raging indignation against most commercial cat food, and levying particularly harsh criticism in the direction of the insanely low quality and absurd species-inappropriate formulations in so-called 'prescription' diets, for two weeks earlier this year, I fed one of those diets.
And I’d do it again if I had to.
My darling, affectionate, beaming-with-health, five-year old Sidney-Beans (aka The Beans, aka Sidney, aka The Sid-meister, aka Beanhead, aka Sir Beanhead, aka Sidney Of All The Beans) had the unthinkable happen to him late last winter.
Although he's never been fed one meal of dry food in his life — the classic and usual culprit in urinary tract blockages in male (and, occasionally, female) cats and possibly one contributor to cystitis (bladder inflammation) — something caused my Sidney-Beans to become blocked.
As I would learn, the “something” that was causing the urethral obstruction in Sidney-Beans could be the result of many factors, including:
- a small bladder stone that moved into the urethra;
- inflammatory debris from cystitis (bladder inflammation);
- a large amount of crystals flowing into the urethra; or.
- a combination of any of the above.
Bear in mind that Sidney-Beans has been on a water-rich diet since he was rescued as a kitten and from the very first day he came home to live with us.
I was, thankfully, home when the urethral blockage first became conspicuously evident. I noticed Beans going to the litter box every few minutes, trying to pee, and not peeing.
I know exactly how dangerous, painful, and life threatening this is. I am aware of the potential for a male cat's bladder to rupture. Even as I was doing my best to stay calm as I scrambled to call my vet, let the emergency vet clinic know we were on our way, get Sidney in the cat carrier, and drive at top speed to the emergency vet clinic, in my head I was arguing with what was happening.
"This is impossible. I've done absolutely everything 'right' here. I never fed him dry food. He just can't be blocked. Cats on a species-appropriate, water-rich diet don’t block."
Any loving cat parent will know this syndrome: no matter how well educated you think you are on many aspects of a cat's health and what to watch out for and ask for if you're facing an emergency with your animal, your brain turns to near-useless neuro-jello when you're in the throes and thick of a crisis with your own cherished animal.
All that prior knowledge from having read Dr. Pierson's carefully crafted web page on the subject of urinary tract health went clear out of my head. I forgot just about e-v-e-r-y t-h-i-n g. I was singularly focused on the immediate nightmare in front of me.
Nothing came into my head except the pressing need to find a way to make this stop as fast as possible. My beloved Beans’ escalating agony magnified my brain freeze. He's normally a docile, calm, and quiet car-rider, yet he was howling in pain for final two miles of the car trip to the vet. He was in awful distress.
Someone I love is in pain. Must stop that pain. We’ve all been there, right?
Any other logic or knowledge that might have informed my clear-headed ability to ask the right questions or direct the vet to take certain steps to help him was, in those moments, inaccessible.
WHY I WAS SO SURE WHAT WAS HAPPENING COULD NEVER HAPPEN
During the drive to the emergency vet clinic, I mentally reviewed what my stressed out brain was capable of remembering.
We know that cats are virtually thirst-less animals. They are engineered by Mother Nature to get their moisture from their food. We know that cats fed dry food are chronically under-hydrated, even with supplemental drinking from a water bowl.
We know it is vital to keep a high volume of water moving through their plumbing. That’s why it’s essential that cats eat a water-rich diet. That way, the bladder is regularly flushed — several times each day — and any grit (crystals or stones) or debris (arising from an inflamed bladder wall) that might begin to accumulate can be washed away, hopefully well before it becomes a potential source of a urethral obstruction.
- Picture taking a hose to your driveway several times every day to clear the gunk away. That’s what we want to do with a cat's bladder. Flush it continuously with water. More water going in, more water going out and flushing the bladder. It’s one of the primary reasons that many of us have been on our bully pulpit for years preaching the gospel of wet food for cats and doing whatever we can to educate veterinarians and cat caregivers about why dry food is an entirely inappropriate diet for a cat.
Many years back, when I first started diving into the subject of cat nutrition, I intersected with Dr. Lisa Pierson, a veterinarian living on the opposite coast. We formed, at first, a close collaborative professional kinship because of our shared interest in the subject. I was the eager layperson hungry for knowledge; she was the one married to science.
I discovered the subject of “species appropriate feeding” because of my eagerness to help my cat, Duke, overcome a chronic and unrelenting digestive disorder that left him with intractable diarrhea. As a vet with many years of experience and a strong interest in helping her cat with chronic diarrhea, she too had begun challenging the dominant paradigm on how we feed cats.
Over the years, our shared fascination over best practices in resolving cat poop problems blossomed into a closer friendship. Some days we even talked about subjects other than feline diarrhea or the pros and cons of covered litter boxes.
As a scientist, Dr. Pierson always brought facts to the table first. I came to count on her for honest and thoughtful critiques around my theories and suggestions to others on cat nutrition. I love having her as an ally and sanity-checker. She keeps me honest.
When Sidney-Beans came into my life as a kitten five years ago to offer companionship for Wilson, a wise and marvelous tabby-cat we adopted as an adult and another bright light of love in the world of cats I have adored, Dr. Pierson and I agreed she would assume the title of “godmother” to these two sweet boys.
WATER. WATER. WATER.
Dr. Pierson was always emphasizing WATER as the most vital, single component that was essential to a cat’s urinary tract health.
My translation of Dr. Pierson’s message? “IT’S THE WATER, STUPID.”
She is specific on this point — that’s it’s the water — not "crystals" or "urine pH" — or any of the expensive, low-quality, "prescription" diets often recommended by veterinarians, that matters more than any other single factor when it comes to giving a cat the best shot at a healthy urinary tract.
Reviewing all of this mentally while I dodged and weaved through heavy DC traffic to get Sidney-Beans to the emergency vet clinic, I was baffled. How on earth could Sidney-Beans possibly be blocked? I fed a water-rich diet. There is no way that this sweet boy has a bladder packed with urine and can’t pee.
But? There he was with exactly that problem. He was growing more miserable by the minute. His yowls grew louder. I grew more desperate.
AT THE EMERGENCY VET CLINIC
The kind folks at the emergency vet clinic knew that I was coming and immediately whisked Sidney away to examine him. I sat chewing my arm off with worry in the next room. The vet confirmed that, yes, he was indeed blocked, and she asked for my permission to immediately administer a painkiller and take whatever steps were needed next.
She explained that he’d be sedated, radiographs (x-rays) would be taken, and that he’d be catheterized to relieve his full bladder through a small tube and flushed out. He’d get intravenous fluids so they could closely monitor and compare fluid input and urine output. Plus they would take bloodwork and perform a urinalysis.
In addition to painkillers (Buprenex), the vet also started him on Prazosin, an antispasmodic drug that is a very effective urethral relaxant. These two interventions (the pain meds + urethral relaxant) were, I learned later, wise and essential. Why?
- TO DULL THE PAIN AND REDUCE THE CYSTITIS-AGGRAVATING STRESS. The painkillers were essential not just for the obvious reason — relieving his physical misery — but also as a way to decrease the stress that comes from pain. For all the many things that the veterinary community still does not fully understand about cystitis in cats, one thing they all agree on is that stress exacerbates the condition. And what’s more stressful than pain? Nothing.
- TO TAME SPASMS. An inflamed bladder and urethra will spasm, and those spasms exacerbate the intense discomfort and pain of cystitis. A relaxed urethra is easier to clear. We needed to tame down those spasms while Sidney-Beans’ very angry bladder, which was now producing cranberry-colored urine that drained from the catheter tube, had a chance to calm down. And we needed to relax the urethra to help clear the current blockage and to help prevent another blockage during the recovery period.
Sidney-Beans was scared and in pain. I was dejected, worried, and confused.
Not long after I got back home, the vet called to let me know that they’d successfully inserted the catheter and that Sidney-Beans’ bladder was now emptying with the aid of that device. Phew. I was relieved to know he was ‘relieving.’
She said the key finding on what was going on came from the radiograph, which revealed that he had several small bladder stones. She explained that they would keep him on the painkillers and antispasmodics, and start him on antibiotics as a precautionary measure in case there was an infection. They would send out a urine sample for a culture and sensitivity test, an endeavor that wouldn’t yield definitive results for three days. The bladder stones, the young vet explained, could be taken care of the next morning with surgery.
I was, in some ways, mildly relieved that we’d identified the problem — or so we assumed — as bladder stones, and that there was a way, albeit invasive, risky and requiring an extended recovery time, to fix what was ailing our beloved Beans.
I gave her the green light (and my credit card number) to schedule the surgery for the following morning. I thought I ought to let Dr. Pierson know what was happening to one of her beloved god-cats.
“HOLD EVERYTHING!” — THE GODMOTHER INTERVENES
I emailed Dr. Pierson to share the bad news about her god-cat. "Sidney's blocked, he’s at the emergency vet, they found bladder stones. Surgery tomorrow morning to remove them."
3.4 seconds after sending that email, a reply, in ALL CAPS, popped into my inbox from Dr. Pierson:
“NO!! STOP! CALLING SHORTLY. DON’T YOU DARE CUT THAT CAT OPEN UNTIL WE TALK!!!!!"
I’ve known Dr. Pierson for a lot of years. She hardly ever uses that many exclamation points. But I know she cares deeply for every cat she knows about, and on reading my email she was adamant that I have the benefit of more information before I went any further with plans for surgery.
I got on the phone with Doc P and told her what I knew.
She asked me many other questions, most of which I couldn’t answer. They were questions I had never thought to ask the attending vet. (See above re: brain neuro-jello).
Before the evening was over, Sidney-Beans’ godmother would call the attending veterinarian, engage her and the staff there to get clear answers to all the questions I didn’t even think of or remember to ask, and help all of us come up with a sound plan for next steps for Sidney.
One day, maybe, I will find an adequate way to thank Dr. Pierson for how she came to our rescue that day. I know now, in hindsight, that the accumulated wisdom she brought to the table on all the issues around urinary tract health made all the difference.
Using her calmest voice, Dr. Pierson replied to my panic-laced blabbering about the bladder stones found on the radiograph and “how we had to get rid of those right away because those were what caused Sidney’s problem” with this:
“Bladder stones are not necessarily what is causing Sidney-Beans' current painful predicament.”
The stones could very well be, she said, a red herring that had nothing whatsoever to do with the obstruction. An “incidental finding.”
This flew in the face of what I wanted to believe. And what the veterinarian taking care of Sidney just told me. That now that we knew he had bladder stones, we had to get rid of them to fix the problem.
While Dr. Pierson and I were talking, of course, I was keenly aware that my sweet, sad little Beans lie drugged, loopy, and confused in his hospital prison cell. He had a catheter stuck up his little urethra, an intravenous drip in his shaved paw, and he was sporting one of those humiliating but necessary soft cone-head things on his sweet little head to keep him from pulling out all those tubes. I had hoped the discovery of bladder stones was the key to unlocking his ability to resume being well again. But it wasn’t as simple as that.
At the same time, even with all my skepticism about trusting vets, I knew I wasn’t completely immune to the “must do what the person in the white lab coat suggests” syndrome. The vet who had examined Sidney was telling me he needed surgery. And here I was on the phone with another vet who was telling me to slow down, to think this through, and to become better informed on all the factors at play before doing something as rash as letting him be cut open.
As much as I liked the attending vet at the emergency clinic, I took a few deep breaths and thought about the contrast between her and Dr. Pierson. The vet who was taking care of Sidney was about a year out of veterinary school. Dr. Pierson had decades more experience under her belt. Even more important, the issue of cat urinary tract health is one that's very near and dear to her and is a subject into which she has put thousands of hours of thought, careful research, and consultation with other specialists in the field. She’s also consulted on hundreds of cases like Sidney’s with very concerned cat parents.
However competent, well meaning, and caring this young vet was, there was no way she had the deep body of knowledge and experience that Dr. Pierson had.
Acknowledging that helped me to open my ears to more of what Dr. Pierson would then explain to me. The wisdom she offered spared Sidney not only from needless surgery, but spared me from moving forward without the benefit of understanding “the other half” of the vital equation about cat urinary tract health.
- It’s not only water that matters, it’s also (wait for it): dietary mineral content.
Those stones, she said, assuming they were struvite-based (they were, as it turned out), could be wiped out in a matter of days — or perhaps two weeks at the outside — with a dissolution diet. Struvite-based stones and crystals, you see, respond beautifully to dietary manipulation. They dissolve in an acidic environment.
The idea with a dissolution diet is that you temporarily feed a deliberately acidic diet, blast the daylights out of those stones, and start over with a stone-free bladder. The ingredient that makes this happen is called DL-methionine
A dissolution diet, she explained, was a much less risky way to take care of the stones. Dr. Pierson — who is as adamant in her objection to 'prescription diets' as anyone I know — screwed up all her courage to answer my next question: “Fine, but how do we do that?”
She knows me well. And from the very first time we communicated many many years ago, she was well aware of the low regard in which I held many commercial pet foods. And the particular loathing I reserved for ‘prescription’ diets.
I heard her pull in a deep, calming breath before she replied: "Well, it’s possible you’re not going to like hearing this, but here it is. You’re going to find some canned Hill’s s/d. I’ve seen it work over and over again. You’re going to feed that, and nothing but that, to Sidney-Beans for the next two weeks. Then you’ll get another set of radiographs to see if those stones are gone — and I’m willing to bet they will be, assuming they’re struvite-based. In the meantime, I’ll walk you through how best to get him through this immediate crisis and, most importantly, we’re going to have a serious talk about how you adjust the diet going forward to minimize the chances he will form stones again.”
She had to repeat all this about 46 times before it sunk in. She’s quite patient. I needed repetition because the first time she said it my brain came to a full stop when I heard, “you’re going to feed a product made by Hill’s.”
What was this coming out of Dr. Pierson’s mouth? My cherished ally in the struggle to educate her colleagues and anyone else who would listen about the folly of many commercial pet foods? The woman whose extensive research and brilliant, logical writing on the subject of so-called ‘prescription/therapeutic’ diets was such a refreshing and thorough and welcome truth-speaking gift to the cat-loving world? The Norma Rae of truth-telling when it comes to the subject of ‘prescription’ diets and what foolish folly they are? She was telling me to feed some of that crap?
She explained that temporary use of this stuff was the exception she makes when it comes to ‘prescription/therapeutic’ diets. And that she’s been clear about that for years on her web page addressing ‘prescription’ diets at the bottom of her Urinary Tract Health web page. She loathes those ‘prescription’ diets too. But when it comes to using s/d briefly in exactly the situation I found myself? Like it or not, she said, it works.
How? The acidity in the food dissolves struvite-based stones fast. Within a matter of days, often, and usually only two weeks at most, depending on the size of the stones.
Dr. Pierson clarified that she much prefers Hill’s s/d over Royal Canin SO because it is highly acidifying: it hits the stones fast and hard to dissolve them rapidly and allows cat parents to get their animals back on the healthy homemade diet quickly — often within one to two weeks, depending on the size of the stone(s) and what the follow-up radiographs show..
My mind scrambled for some alternative to feeding any Hill’s product. “But, umm, couldn’t I make something myself, that had the same dissolution-magic ingredient?”
“Sure, you could do that,” she answered, adding, “but first you need to get your hands quickly on some DL-methionine. And then you need to make the food. And then you need to pray that it works as well as something that I already know with certainty works. And we need to get my god-cat moving in the right direction as soon as possible. This is only for two weeks, and maybe for the sake of my god-cat, you’d consider it?”
When pressed, she admitted that she was concerned that her god-cat would be able to look hot and scar-free in his Speedo come summertime. So if there was a way to avoid surgery, I should definitely try the dissolution diet first.
I considered her suggestion carefully. It made sense. And it was time for me to suck it up and stop being stubborn and dogmatic. To do what I need to do for the sake of The Beans. To go buy some of this stuff and get some cans over to the vet clinic so they can start feeding it to Sidney-Beans as soon as possible.
Before we dove further into our conversation — Doc P said we still had to cover some important ground so I could put my head around some dietary changes I needed to consider going forward — I stopped to phone the vet to let her know the plan and to tell her to cancel the surgery scheduled for the next morning. The vet consulted with one of the more senior and experienced doctors at the clinic who agreed it was definitely worth a shot.
I missed that little goofball something fierce, and the vet said I was welcome to come by first thing in the morning to visit him when I bring over the new food and give him some snuggles and love. With any luck, she said, he might be home by the following evening or early the day after that. They wouldn’t release him until they were sure he could pee on his own, after the catheter was removed.
I’m going to jump ahead in this story with a spoiler alert: the dissolution diet worked. Followup radiographs taken two weeks after feeding the food (which smelled like a rotting corpse to me, but I digress) showed no sign of the stones.
IT’S NOT JUST THE WATER: IT’S THE MINERALS TOO, STUPID
Once I was satisfied that trying the dissolution diet was the sanest approach and I had reason to believe Sidney-Beans might be able to come home reasonably soon and so I could breathe a little again, the next question I had for Dr. Pierson was: but why did Sidney-Beans form those stones in the first place? And if the bladder stones were potentially nothing more than some 'incidental finding' unrelated to the urethral blockage and the painful bladder inflammation (cystitis) that had him hospitalized, what on earth was going on?
How could we get through this? And how could I prevent this from happening again?
As she always does so well, Dr. Pierson reviewed some of the essential facts that were necessary for me to appreciate the full picture. Did I mention she’s incredibly thorough? Compassionate? Fact-based?
She emphasized that there is still much that the veterinary community does not know about some of these urinary tract issues, particularly cystitis, and that there are many factors that come into play, some of which we know about and understand (and therefore can manipulate and control), and some of which we don't.
Into the former category — stuff we know and can do something about — fall two distinct but related issues: 1) “water” (yeah, yeah, I’ve already got that covered – get water flushing through the bladder, can we move on already?), and; 2) mineral content of the diet.
Mineral content. What? Oh, right. If the mineral content (for simplification: bone = mineral content) is too high, a cat now has the building blocks to create bladder stones and/or excess crystals.
If the mineral content is not too high, the body is denied the ‘substrate’ — the building blocks (magnesium, phosphorus, and calcium) — needed to create those nasty stones or excess crystals. Dr. Pierson said that I was probably giving Sidney-Beans too many of those "building blocks.” She shared that she has long been concerned that our collective assumption that cats in their natural environment consume all the bone in all their prey all the time may be off the mark.
“Ever watch any of those National Geographic specials showing cats in the wild killing and eating their prey? They don’t eat all the bone. They eat some of the bone — often very little. This whole thesis we’ve had about feeding ‘whole carcasses’ guaranteeing the best meat-to-bone ratio is one I’ve been suspicious of for some time, and increasingly so in recent years.”
A light bulb lit up for me when she raised the possibility that I was feeding too much bone. I remembered only then that up until about six months earlier, I had always been adding lots of extra muscle meat in the form of chicken hearts to the diet (following the recipe I'd used for years) but had stopped that as part of an experiment cutting out all chicken protein from my boys' diet.
- In other words, up until about six months prior to Sidney Beans’ urethral obstruction, I'd been feeding, effectively, a lower proportion of mineral content in the diet because when extra boneless meat is added to a with-bones recipe, the bone material is diluted.
The solution to this? Here’s the good news. It’s simple. Feed less bone. You don’t need some prescription urinary maintenance diet to achieve the goal.
I committed then and there to adjusting the homemade food recipe I used for my boys to reduce the overall bone content. FYI, I now make batches of food that consist of 50 percent whole carcass (“meat with bone”) and 50 percent “boneless meat.” By the way, if I was making food using just chicken thighs, as many people do, Dr. Pierson recommended removing about one-third of the bones.
I told Dr. Pierson that I thought I understood this now, but since I was tired and stressed, I wasn’t sure I’d absorbed it. Wisely, she asked me to explain what I’d now come to understand from our conversation so far. I said, “Okay, so Sidney got blocked because of stones created by too much mineral substrate, and . . .”
Before I could finish my sentence, she gently interrupted me.
She began again: “Anne, we do NOT know that Sidney’s blockage had anything to do with those stones. We know that he HAS stones and that we want to get rid of them. And we’re going to do that with a dissolution diet. But we don’t know that it was a stone that blocked his urethra. For all we know it was the mucous inflammatory debris from cystitis, possibly mixed with crystalline material, that caused his urethra to obstruct.”
She again went over the list of variables and possible causes: a small bladder stone that moved into the urethra; inflammatory debris from cystitis (bladder inflammation); a large amount of crystals flowing into the urethra; or a combination of any of these.
“So crystals are a big problem?” I asked.
Dr. Pierson then shared her exasperation over vets who alarm cat caregivers when reporting the discovery that crystals were discovered in a cat’s urine. “Crystals,” she explained, “are not necessarily an abnormal or troublesome finding in cat urine. In highly concentrated urine they can be a very normal finding. And they are definitely not any reason to reflexively reach for some 'prescription' diet. Cystitis and stones don’t always go together. There are plenty of cats with stones that have no cystitis. And there are plenty of cats with cystitis that don't have stones.”
I think I was finally starting to sort-of kind-of get it. She explained some more to me about what happens to a cat’s bladder when it’s inflamed from cystitis, how antibiotics are not called for unless we knew for certain there is an infection, and what to expect when I brought him home. This went on for hours.
Well aware of how compromised my brain had become and how tired I was — and correctly concerned I would not remember any of this if I didn’t repeat it back to her, she asked me to tell her what I now understood from my crash education on cat urinary tract health, particularly as it applied to what I needed to know to help Sidney.
- We know from the radiographs that Sidney has bladder stones. I can pretty safely surmise we know that too much mineral content in the diet might well have led to the stone formation. I suck for having been inattentive to the possible consequences of having stopped diluting his food with extra muscle meat and that will never happen again.
- I will use a dissolution diet to blast those stones to smithereens, and once we’ve confirmed through a set of two radiographs that it worked, I will reduce the mineral (bone) content in his diet from that day forward forever to reduce the substrate that makes it easier for those stones to form.
- It may not have been the stones, per se, but rather the cystitis, which was, possibly, the primary cause — or a prominent contributor to — the life-threatening urethral obstruction that happened to Sidney. Obstructions can be, and usually are, multi-factorial.
- I will get over myself and my pomposity as well as my (understandable and generally wholly justifiable) reflexive distaste for feeding commercial food for two weeks and put on a disguise tomorrow to find a local vet clinic that has it in stock to deliver it to the emergency clinic so Sidney can start on that food as soon as possible.
- We know that Sidney blocked. We know he has an angry bladder (cranberry colored blood, etc.) that tells us he has cystitis. We don’t know yet, and won’t definitively for three more days, whether he also has an infection going on. If we learn that this is ‘sterile’ cystitis (no infection), we will discontinue the antibiotics immediately. If we learn that it is an infection, the culture and sensitivity test being run will tell us what kind of bacteria it is so we can be sure we’re using the right antibiotic. (Spoiler alert – it was confirmed that, in fact, he had no infection.)
- When I bring him home, I will keep him on the painkiller (Buprenex) and the antispasmodic (Prazosin) medication for a minimum of three days but, more likely, a week. I will not take him off those drugs until at least two or three days have passed AFTER symptoms disappear. I will do this because I know how important it is to relieve his pain — and the attendant stress from pain. I will keep him on the antispasmodics as well because his urethra and bladder are very pissed off and will have just suffered the necessary assault of having a foreign object shoved into it.
- It is quite common for cats to have difficulty urinating once the urinary catheter has been removed because the catheter has irritated the delicate lining of the urethra causing it to spasm/close down. This is why I should continue to give Sidney-Beans Prazosin for at least three to four days, or potentially a full week, after the catheter is removed. The antispasmodics will help alleviate those urethral spasms so the roadway stays open. The Prazosin may also make his bladder more comfortable.
- I will keep a constant eye on him in the early days and weeks when I bring him home to make sure he doesn’t block again. I will remember not to freak out when I see him making continual trips to the litter box, or licking his genital area more than usual, especially in the early days after he returns home, because I will remember how much his bladder and urethra has have been through and how irritated they still must be. I will take him back to the emergency vet immediately if I suspect he’s blocked.
- I will feed him cans of Hill’s s/d until I get new radiographs in two weeks and I will not complain to her every day in an email about how it kills me to feed this food.
- When all this is over and behind us and we’re all safely on the other side of this crisis, I will write a blog to share with my readers about everything I’ve learned so that other cat caregivers can learn from all this too.
- I am then free to resume my harsh and correct critique of many commercial cat foods (and always, always, absolutely any dry food) so long as I remember that there is a place, in some limited and extenuating circumstances, where making temporary use of s/d may be the best choice to spare a cat from misery, pain - and surgery!
HOW DID ALL THIS WORK OUT FOR SIDNEY-BEANS?
The next morning, I went to the vet clinic to visit Sidney. It took me longer than I’d hoped to find some canned s/d to take to him. They didn’t stock it in the emergency vet clinic — I sure as heck hope they do now — and I had to first get written permission in the form of a prescription from the vet to pick up a case I finally found after calling around to several veterinary clinics.
Armed with s/d and after making sure the vet techs all understood that while he was in their care, he was to eat NOTHING but this food, I finally found my way over to his cage so I could see my fellow.
He looked so sad and pathetic. And he was purring and happy to see me.
He was kooky and wobbly from the painkillers, but at least his bladder was still emptying thanks to the catheter. It was cranberry-colored (bloody) urine, to be sure, but we were starting to move in the right direction. I opened his prison cage enough to be able to give him some snuggles and kisses, though it was tricky to navigate the challenge of accessing him inside a cage given tangle of IV tubes and the catheter stuck in his poor little weenie. Plus he had that cone-head thing on his head so he looked like a dazed space alien whose baby sister was teasing him by making him wear some ill-fitting dress-up cone-hat. But he was still my Sidney.
I overstayed my welcome at the vet clinic for as long as they could stand me there and headed home again.
They released him later that evening after they’d removed the catheter and confirmed that he could pee on his own. I came home with Sidney, Buprenex (painkiller), Prazosin (antispasmodic), antibiotics (which I’d discontinue a couple days later after the culture revealed there was no infection), and newfound humility.
By the way, Sidney loved eating that stinky s/d stuff. LOVED it. He was so thrilled gobbling down that smelly canned food. It bruised my ego. I got over it. I only wanted him well.
I was so grateful that Dr. Pierson had forewarned me about the first several days of Sidney-Beans’ recovery at home. He was, as she’d suggested would likely happen, still visiting the litter box continuously, sometimes every five minutes when he first woke up. But he was peeing something each time, so I knew he at least wasn’t blocking. Because I use clumping litter, it was easy for me to tell when he had successfully peed and how much urine he passed as judged by the size of the pee ball.
The Sidmeister and me, we spent about four full days together where he was within in my sight at nearly all times. We huddled in the guest bedroom with an iPad, a litter box, blankets, and a journal where I logged the frequency and size of his pee-balls with the precision of a NASA mathematician intent on calculating the correct trajectory to land a drone on the surface of Pluto. I kept careful watch to ensure he didn't block again. It was a profound bonding experience that I hope to never go through again.
Now? I feed the exact same recipe I've fed for years, but I make batches that consist of 50 percent "whole carcass with bone" meat and 50 percent "boneless meat." FYI, Dr. Pierson doesn't use whole carcass in her diet, she uses chicken thighs and removes one-third of the bone. Check out the way she makes her food — it's awesome.
My regular vet who handled the follow-up radiographs two weeks after Sidney came home — she's a wickedly cool character overall with many decades of veterinary experience under her belt and a delightfully logical sort — wasn't one bit surprised.
I shared with her the hair-raising story of that night, how close I came to authorizing invasive surgery, my long calls with Dr. Pierson (whom my vet admires a great deal; Dr. Pierson’s reputation precedes her!), my baptism by fire into the world of urinary tract issues in cats, my worries for other folks who didn’t have the benefit of knowing there was a safer alternative than surgery for struvite-based bladder stones, and she nodded in agreement.
She said to me that fresh-out-school vets do the best they can with what they know and what they’ve been taught, but that there is no substitute for years of experience and a the accumulated wisdom and insight that comes from having few gray hairs.
She snickered when I told her about my eating crow, for two weeks, to feed s/d. She agreed that the ‘prescription diets’ were largely a ridiculous racket, but said that when it came to short-term use of s/d, in her experience it “works quite beautifully and perfectly for this very purpose nearly every time." She was fully on board with my plan to return to feeding him the homemade raw diet I've fed for years, but with one important change: less bone.
Today, nearly seven months after The Terrible Episode, I’m happy to report that, so far, Sidney is doing mighty fine. I watch his peeing habits more closely than ever before (so far, so good). Once the radiograph confirmed the stones were gone, I began serving him (and Wilson) the regular homemade food again, albeit with a recipe that contains considerably less bone.
I hope no one reading this ever needs the information below, but here’s the list I wish I had in my head (or printed and handy somewhere) when I first showed up at the emergency vet clinic with my blocked cat.
√ Painkillers (Buprenex) ASAP
√ Your cat should be getting antispasmodic medication (Prazosin) to relieve urinary spasms - these should be continued for at least 24-48 hours AFTER all obvious symptoms (i.e. bloody urine, small pee balls) are resolved. Make sure your vet sends you home with enough.
√ Your cat should be getting pain medication (Buprenex) to stave off pain - this should be continued for 24-48 hours AFTER all obvious symptoms (i.e. bloody urine, small pee balls) are resolved. Make sure your vet sends you home with enough.
√ Your cat will be sedated and then catheterized to relieve his blockage - they take a urine sample to look for bacteria, crystals, etc.
√ Insist that they run a "culture and sensitivity" test on the urine; this will go to a lab for a three-day test to determine if there's an infection and, if there is, what kind it is so the correct antibiotics can be administered; this is far better than 'guessing' and giving the wrong antibiotic and will tell you if the cat needs to be on antibiotics at all. Be forewarned that many vets opt to not run a C & S because it will add approximately $200 to the invoice amount.
√ Insist that your vet send out a urinalysis to an outside lab (in addition to a culture and sensitivity test if you can afford it) but insist that they look for crystals right away (within ~20-30 minutes of the urine leaving the bladder) as well. The reason for this 'in-house' urine exam is that crystals can form within 20-30 minutes of the urine leaving the bladder. Therefore, if they are found on a send-out test (many hours later), you will not know if they were actually inside your cat, or formed after the urine was voided.
√ If bladder stones ("uroliths" or "cystoliths") are found - drill down to learn more - you want detail; how big are they? how many are present?
√ If surgery is suggested to remove stones, pause. Breathe. Be wary of suggestion that stones must be removed surgically - you don't know that they caused the problem in the first place and there's no reason to subject the cat to the additional stress and risk of surgery unnecessarily. Try a dissolution diet first - if you've reason to believe the stones are struvite. A dissolution diet acidifies the urine and that can dissolve one common type of stone.
√ KNOW that the two most common types of crystals and stones are struvite and calcium oxalate: Remember that the dissolution diet (i.e., Hill's s/d) can only dissolve struvite, not calcium oxalate stones, or other (more rare) types of stones.
√ When the catheter is placed - ensure that the vet is also flushing the bladder to clear out any accumulated sludge! Don't assume this is happening. Ask and insist on copious flushing.
√ IV fluids will be administered so they can flush the bladder and closely monitor fluid input and urine output.
√ Insist on details from the urine sample that's taken after he's catheterized - bacteria yes or no? What kind of crystals did they see? How many (quantify - lots? a few?)
√ They will x-ray the cat after the catheter is placed - insist on a two-view radiograph to get the best picture of what is going on (i.e., are there stones?)
√ If the cat is put on the dissolution diet (key acidifying ingredient in it is DL-methionine) it must be short term only; Hill's s/d is Dr. Pierson's first choice because it is aggressively-acidifying and will act faster than Royal Canin SO. SO is technically 'approved' for long-term use because it is a weaker acidifying diet but it is a poor quality diet and not one that you would ever want to use long term. Therefore, you may as well hit the stones hard and fast with canned (not dry) s/d and then move back to your homemade diet.
√ KNOW: The perils of ‘free catch samples.’ From Dr. Pierson’s site: A urine culture and sensitivity (C & S) is not accurate from a free-catch sample due to contamination issues. However, on rare occasions we may run a C & S from a midstream sample that is caught in a sterile container but interpretation must take into consideration the collection method. If the C & S comes back negative on a free-catch sample, this result is helpful but if it comes back positive, you cannot be sure if the bacteria are from the bladder/kidney or from the very end of the urinary tract or the patient's hair that surrounds the vulva or penis. A check for crystals is also not accurate because crystals can form once outside of the bladder in as quickly as 20 to 30 minutes. This problem of a 'false positive' can be an issue with urine obtained from a free-catch sample at home, as well as one obtained via cystocentesis that is sent to an outside lab due to the same time delay. This is why you want to insist that your vet examine the urine for crystals, in-house, as soon as the urine is obtained from the bladder. (See Dr. Pierson's Urinary Tract Health page for more details.)
√ Why feed Hill’s s/d in this situation (blocked cat, struvite suspected)? Because while theoretically there would be a way to create a home-prepared diet adding DL-methionine, the amount to add to the diet is not clear and - like it or not - the s/d works in nearly all cases. Plus, when your cat is in crisis, you’re not in good shape to begin researching diets - you just want your cat out of pain, and the stone(s) dissolved. You can then adjust the diet going forward to reduce the stone/crystal-creating minerals by adding less bone to the diet. You do NOT need to continue with a prescription diet!
√ Always say "no!" to any use of Metacam or Convenia if those are suggested - ensure that your vet, the techs, everyone at the vet clinic is clear that these drugs are never to be used on your cat - EVER. Dr. Pierson has devoted an entire webpage to the use of Convenia on her website if you would like to learn more about this drug.
There is more to know and learn about urinary tract health – about issues around urine-specific gravity, home pH testing, and much more. I highly recommend visiting Dr. Pierson’s web page to learn more on those subjects.