Pet Lovers

[lynne6was7]

Hello to our resident cat expert @Sammycat1 .  I have a "What Would You Do" question.

My Kiki is 15 1/2 years old.  She just had her 6-month check-up last Monday.  My longtime vet says she looks great - plush, shiny fur and good muscle tone - and her blood panel came back with good results, especially with respect to kidney and thyroid readings.  All readings stable since last done in July.

Kiki's kidneys are full of calcium oxalate stones.  I adopted her from a reputable local rescue 6 1/2 years ago and she was being surrendered because she had ongoing issues with stones in her bladder and her family could not afford her care.  THESE STONES DO NOT ORIGINATE IN HER BLADDER.  THEY MIGRATE FROM HER KIDNEYS.  Since Kiki has been with me, she had one major kidney stone migration in August 2018.  She was on pain meds for about 10 days and ultimately the ultrasound showed that three stones had migrated to her bladder.  We left them.  She eats Royal Canin SO kibble (which can dissolve struvite stones but not calcium oxalate stones) which encourages her to drink a lot of water to keep her kidneys and bladder flushed.  She also takes cosequin every day, which I've been told is also good for bladder health.  The stones in her bladder have not caused her to strain in the litter box and she has not appeared to be in pain or uncomfortable.  She is a very active and agile senior kiitty.  She plays, runs and jumps every day.  She stretches out long and enjoys full body massages with no tender spots.  She eats and drinks well, and has good output of both kinds in the litter box every day.

Here's the problem:  Because of jostling from the car ride and the vet visit last Monday, she had another stone migration on Friday.  She cried once while doing a normal  #2.  Then went to the other box to do #1, and there was some blood in the normal, good sized clump of urine.  She sat hunched and revisited the box to produce a couple small clumps of urine  My vet clinic has changed the way they do diagnostics, and she had to go to the emergency vet for x-ray and ultrasound to make sure there was no blockage - there was not.  But there are two "big" stones in her bladder along with some tiny ones.  They gave her a pain injection.  Tested her for a bladder infection - while she did not have a full-blown infection, they thought it best to give her an antibiotic injection.  They also gave her fluids to flush her kidneys and bladder.

After being home for 18 hours, she was pretty much back to herself in all respects and has continued to be through today.  She does not appear to be uncomfortable.  Therefore, my conclusion is that she was in pain and discomfort during and immediately following the stone migration but the stones in her bladder are not bothering her.

The ER vet recommended surgery to remove the stones from her bladder.  My vet reviewed the ER records (but had not yet seen the x-ray or ultrasound when we talked, and would like to do surgery tomorrow while Kiki is on the antibiotics.

I trust my vet.  She did successful dental surgery on Kiki twice for resorptive lesions - last time in January 2020.

Would you go ahead with the surgery to remove the bladder stones, given that Kiki is in very good health but 15 1/2?  Also given that her kidneys remain full of stones that could migrate again at any time - especially with another ride in the car to a vet visit?  We cannot dissolve the stones in her kidneys, and there are way too many to break up with ultrasound.  We can change her diet going forward to try to prevent the formation of more calcium oxalate stones.  She has always been given filtered water while I have owned her.

Thanks for any input you can provide.

[NickNack]

@Sammycat1  paging you for @lynne6was7 .  lynne6was7 you have to page the person within the message.  It doesn't work just in the title of the post.  

I know you weren't asking me, but I don't know what I'd do in your position.  That's a really tough one considering this will continue to happen and she's so old.  I think I'd have to think about it for a while.

[lynne6was7]

Thank you, @NickNack , for pointing me in the right direction.

[Sammycat1]

@lynne6was7 

I've read your post and given it some serious thought. I've had a male cat with a bladder stone problem, but not a female.

Here is my fundamental question for you and her vet this evening:  Does the long-term benefit to do surgery to remove the bladder stones outweigh the considerable risk of undergoing general anesthesia and having surgery now?  So, considerations:

- On the kidney front: Although her kidneys seem OK, they have to be 75% insufficient to even register on blood work. In other words, she's an old cat, and all cats progressively lose kidney function. Have you seen her BUN and creatinine with your own eyes? Where in the normal range does she fall ?

Also, there is a refined blood test called SDMA to give your vet a better idea of right where she is. I've had this administered before I give a thumbs up/down to surgery because the anesthesia can accelerate things rapidly. It happened to us once before the availability of SDMA where we live, throwing our cat into acute kidney failure after routine surgery. He did not recover.

- Has her blood pressure been measured? This is critical to know ahead of time.

- If your vet goes ahead with the surgery, will Kiki be on fluids before, during and after to protect her?

- On the stones front:  I read your post a few times but what wasn't obvious was--why take the bladder stones now? Is this a life-and-death emergency in their view? Are they afraid of internal bleeding because of the size of the stones? Are they concerned about an infection brewing in the near future that might take her life? Do both vets fear imminent obstruction? If the answer to enough of these is yes, there's no other consideration.

- But, taking a broader view, if there is not an urgency/emergency: there are board-certified vets who can circumvent this long cycle for Kiki by doing ureterotomy and urethrostomy when they remove the stones...in other words, creating bigger pathways from kidneys to bladder and beyond so that nothing can get stuck in the future. I don't know if this is possible for Kiki at her age, but it's worth asking about.

The reason I ask is this is that many cats hate the diet you're talking about because it's pretty bland and it only works if that's all they eat. If so, then you're stuck moving forward with having only removed bladder stones, without having looked at the big picture to deal with the bladder-removal plus creating those wider openings at the same time.

You know, I'm not one to be running to a specialty vet because we don't have any near us plus, well, cost--plus, they don't know my cat. But when Frankie developed feline stomatitis to the point that all the teeth had to go very soon I'm glad my vet said that he could do it, but he didn't have dental x-rays to check for every stitch of tooth or root. One piece left behind could have been catastrophic. Plus his OR wasn't equipped for what she needed, as she has a crappy liver and pancreas, and the general anesthesia was very risky. You get the picture. He gave her pain meds to hold her over until we got the consult with the dental vet, who confirmed our regular vet's assessment then did the procedure at his place. It saved her life.

So, bottom line:  Your vet's skills and opinions carry the most weight. But I'd want more detail on her kidney strength before saying yes, and I'd need to do know why do the surgery now ... especially because those kidney stones are just going to keep migrating and you could find yourself back where you started a month later. I'd want to know the broadest and best solution for her, her age and those kidneys that will keep pitching stones into the bladder. Also, can your vet refer you to a specialist for an opinion?

(Also, moving forward, can they provide you with the pain medication at home and dosing instructions so that you can relieve her pain immediately?)

I asked more questions than I answered, but I'm trying to think out loud with you. I hope my train of thought helps you; these are the issues I'd be thinking through if Kiki was mine. What are yours? You know Kiki better than anyone.

[Sammycat1]

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@NickNack wrote:

@Sammycat1  paging you for @lynne6was7 .  lynne6was7 you have to page the person within the message.  It doesn't work just in the title of the post.  

I know you weren't asking me, but I don't know what I'd do in your position.  That's a really tough one considering this will continue to happen and she's so old.  I think I'd have to think about it for a while.

---

@NickNack 

Thanks for pointing this my way. @lynne6was7  and I have been friends via a lot of cats over the years!

[lynne6was7]

Thank you @Sammycat1. I knew you'd lead me toward the right questions to ask. I'm also questioning the logic of removing these stones when a) we left three stones in her bladder in August 2018 and some or all eventually passed, or some remained but haven't caused her discomfort; and b) there is no guarantee that additional stones won't migrate at any time. I could OK this surgery and we'd be back in the same situation by week's end. In my 35 years of being owned by 11 kitties, I had two develop true bladder stones. One was a male who was so clever that he tapped my arm and pantomimed that he couldn't pee. He needed surgery, as male cats usually do, to clear a blockage. My female kitty was treated with special food to dissolve her stones. But she was uncomfortable, revisiting the box and scratching. Kiki has never done that - only last Friday, as or after the stones migrated. I can see a lot more dialogue needs to happen. Thank you.

[lynne6was7]

I should have added that I monitor Kiki carefully at all times. If she began frantically scratching in her box, I would know something was wrong and needed to be addressed. I would also know immediately if she wasn't passing urine.

[Sammycat1]

@lynne6was7 

You're welcome. And I know you are Cat Mom Extraordinaire and will watch your baby like a hawk. 

Let me know what you discover and how Kiki is doing!

Edited to add:  The vets' thinking might be that the stones are big and could cause an obstruction--then you're heading to emergency surgery vs. doing it now in a more controlled fashion. But it's a question worth asking!

[Marp]

@lynne6was7,  I read that Kiki has only had filtered water.  Am I correct that you are referring to tap water that runs through a filter?

If so I can't urge you strongly enough to change to bottled water.

I have had a male cat and a male dog that developed calcium oxalate stones that eventually needed to be surgically removed. 

Without going into a long story the only change I ultimately made was to change to bottled water and neither had a repeat occurrence.

In Kiki's case changing to bottled water would not help with the stones that have already formed but it may help slow or even prevent more stones from growing or developing.

@Sammycat1,  you are such a valuable asset to this board.  Thank you for sharing your knowledge.  You are a treasure.

[lynne6was7]

Well, Kiki is at the vet and will have her surgery mid-day today.  My vet and I traded emails last evening.  I laid out my thoughts and concerns, and she was kind enough to respond after hours and also send me a photo of Kik's x-ray.

She said that two of the stones are too large to pass.  Therefore, they could present a future obstruction risk which, as you said @Sammycat1 , would then be an emergency.  They could also breed infection that could spread from her bladder to her kidneys.  Right now, we know Kiki is infection-free so it's the ideal time for surgery.

Kiki's vet has always been very aware of the kidney issues and keeps that in mind when selecting anesthesia and other medications.  She also ramps up the fluids during and around Kiki's surgeries (dental in the past) to flush her kidneys.

Prayers for Kiki will be appreciated.  Hopefully I can pick her up early evening.

Thanks for all your input. @Marp, yes, I did mean filtered tap water.  I have a telephone consultation scheduled with a vet from the ER clinic who specializes in dietary plans for kitties like Kiki.  I will discuss water with her as well.  Thanks for the reminder.