FLUTD

Question 1

• 7 year old FN DSH
• History of recurrent cystitis

Last time she presented with similar clinical signs in June 2015 you did a complete urinalysis and performed contrast radiography – no abnormalities were detected

• Poppy is on a wet cat food diet of varying types
• She has Cystease capsules when her owners remember
• In the past she has had injections of Rimadyl (carprofen) when she has bouts of cystitis
• Dr Resnich’s wife has just had a baby and Poppy is now being confined to the kitchen and conservatory
• Poppy has started urinating small amounts of red discoloured urine all over the kitchen surfaces. She cries every time she urinates.
• Dr Resnich is annoyed and wants you to cure his cat
• He is finding it hard to explain to his wife what is going on
• He wants to know if he can use long term anti-inflammatories. He is a rheumatoid arthritis specialist and uses long-term NSAIDS in his patients all the time and this is an inflammatory condition isn’t it?

Answer 1

• Multiple factors contributing to FLUTD. However through a placebo study, it has been shown that there is little benefit. There is more of a neuro-inflammation which does not respond to the meloxicam.
• May be more beneficial to address husbandry and environmental aspects of the management

Question 2

§What do you think the trigger for this bout of cystitis is and why? Explain the pathophysiology

Answer 2

§Stress and environmental change –cortisol production - leads to release of substances from nerve endings causing pain, swelling, vascular leaking, hyperirritability, inflammation, altered GAG.

§In normal cats stress causes activation of the hypothalamic pituitary adrenal axis with increased activity in the area of the brain dealing with vigilance and autonomic activity, increased catecholamine release, enhanced adrenal sensitivity to ACTH, increased secretion of glucocorticoids.

§In the normal situation one of the many glucocorticoid functions is to provide negative feedback and control the stress response.

§Cats with FIC and people suffering from some chronic pain syndromes essentially have an uncoupling of the

hypothalamic-pituitary-adrenal axis they

are less able to cope with stress and

have abnormal responses to stress

Question 3

§What can you do about FLUTD? Devise a treatment plan for Poppy

Answer 3

• Urinalysis including sediment exam and potentially urine culture
  
  • Collected by cystocentesis
• Radiograph – anatomical defect, neoplasia, uroliths, blockage
• Ultrasound – stones, neoplasia, anatomical defect
• Biopsy?
• Pain relief – NSAID/opiod
• Treatment dependent on cause - assume FIC
  
  • Possibly flush the bladder – saline
  • Check quality of wet food, therapeutic diet
  • Ensure water available, many places
  • Cat pheromones
  • reduce stress (spend time with, outdoors available, interesting environement)
• Try other therapies: feliway pheromoenes, giving poppy a place she can hide, ensure she is getting enough attention
• Can try other drugs although no strong evidence: Anxiolytics, Muscle relaxants and Glycosaminoglycans

Question 4

Can we use long-term NSAIDS in cats with FLUTD? Which ones are licensed? Poppy weighs 5.7kg – calculate a dose

0.3mg/kg

Answer 4

Meloxicam oral

Meloxicam – 0.3mg/kg = 1.71mg

Question 5

§Can we use any other analgesics long term for FLUTD?

Answer 5

Analgesia can be used short term to help with a flare up

NSAIDs, buprenorphine and/or maropitant (NK-1 antagonist, potent visceral analgesic [Niyom et al, 2013] and blocker of substance P activation) may reduce clinical signs. However, they are rarely sufficient alone – combine with environmental and dietary modifications.

Anxiolytics may provide some pain relief

Question 6

Is it worth using GAG supplements for FLUTD?

Answer 6

A study showed that there was no overall benefit. However, won’t do any harm so may be beneficial to at least try it. Work by lining the bladder.

Glycosaminoglycans may be beneficial if exogenous GAG attaches to the defective urothelium and decreases its permeability. They may also have analgesic and anti-inflammatory properties

Question 7

•Write down clear instructions, suitable for a lay person for Dr Resnich to give to his wife about all the management/treatment options you suggest

Answer 7

•management/treatment options you suggest

–At the moment – NSAIDs, access to water- multiple sources, wet food, new litter tray.

–Longer term – minimise stress

–Outside access, environmental enricnhment, spend time with, pheromones

• Therapeutic food?
• Manage when flares up
• Do tend to decrease when get older