# Male cat with crystals in urine - updated 1/09/07



## morea (Feb 8, 2005)

My baby, Martell, has been diagnosed with crystals in his urine.

I had previously been feeding all my cats Chicken Soup for the Cat Lovers Soul (dry food) supplemented with Felidae canned food. I have done a lot of reading on Cat Forum and I see that a canned food diet is highly recommended over a dry food diet. 

My vet prescribed a dry food diet (Hills Diet c/d dry) for Martell, and also told me that I could feed all 3 of my cats the same food, as it would be "better" for them. (Better than what?!)

I expressed my concerns over the list of ingredients in the Hills Diet, but was told that Martell could die from his condition if he didn't eat the food she prescribed for him, or I could take my chances with the prescription food, even if I didn't like the look of the list of ingredients. I was terribly shaken up by the diagnosis, so I didn't question it, and have been feeding all 3 cats the Hills Diet (W/D not C/D, since they are indoors only and they really do not need a full-fat food) for about a month and a half. 

Martell has been on the Hills Diet for a few months longer than that, and when I took him in for his follow up appointment at the vet, she told me that the urine sample I brought in still had crystals in it. *sob*

Now, I've been researching this condition online (including several helpful threads here, thank you, Cat Forum!) and have come to a few conclusions:

- all 3 cats should be eating wet food

- the prescription diet is like a medication, and should only be fed to Martell, not to the cats who are not troubled by FLUTD

- I should be providing distilled (or demineralized) water, as our water is hard and high in mineral deposits. I am not sure where to get distilled water, but I checked the phone book and found a few places locally that seem to carry it. I may also be able to make it myself if I can find a compressor. 

My parents lost a cat a few years ago to this condition, despite diet changes and surgery. 

I am so scared and confused by this whole thing, and do not feel that I have been getting good enough answers from my vet. I don't know if this is because she doesn't know enough about this condition, or if she simply can't be bothered, but either way, I can't risk my baby's life over it!

I have also just moved from NY, USA to Canada, and need to find a new vet here. 


What I am hoping for here is:

- that you can let me know if my conclusions are sound

- tips on finding a great vet in my new area

- any advice on this condition, as I am sure there is a LOT out there I haven't found (including higher quality foods!)

- maybe some encouragement. This is pretty scary and overwhelming. 


Thanks in advance for any assistance.


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## coaster (Dec 1, 2004)

Sorry to hear that, but I just went through that with Twinkie and you and he can get through it.



> - all 3 cats should be eating wet food


Yes



> the prescription diet is like a medication, and should only be fed to Martell, not to the cats who are not troubled by FLUTD


Well, that depends if it's the _dissolution_ formula or the _maintenance_ formula. I don't remember which is which in the Hill's line. There's s/d and c/d and I can't keep them straight. BTW, Hills also makes these prescription foods as a wet formula. You can feed all three cats the maintenance formula safely. Martell should be getting the dissolution formula until his crystal count is back down to normal (there's always a few.)



> I should be providing distilled (or demineralized) water


Yes, that's a good idea. Distilled water is sold in the grocery store.

I'd suggest sticking with the prescription food (get the wet formula) until he's free of crystals. Those are the only foods that have been proven by clinical trials to actually work. If you don't like the Hill's, there are struvite crystals formulas also made by Purina, Royal Canin, and Eukanuba. IMO the RC Urinary SO is the best of the bunch.

Good luck!! You can do it!!


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## OrangeJulius (Aug 23, 2006)

*yep*

Agree with above.
Julius gets his own eating room twice a day because I want the other cats to be on normal food, but gives some to the other male.


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## Nell (Apr 7, 2005)

I'm pretty sure it's the s/d that is supposed to dissolve the crystals, and I think c/d is designed more as a maintanance diet. S/d is very acidic and keeping a cat on the s/d for a long period of time will result in calcium oxalate crystals (stones). When the cat no longer has the crystals, the maintanance diet is the one that the vets usually prescribe. 
Maybe your vet put him on the maintanance diet right away instead of s/d first? That could be why the crystals are still there....

I have heard, too, that Royal Canin prescription diets are better than SD, but I've found that the RC is far less common in the states and more common in Canada. 
Tim, have you had luck finding it around this area or would it have to be ordered online?

My friend's (ex-roomie) 2 cats have both had crystals recently, so I've been trying to find out as much as I can about treatment and options for food. She really hates to be feeding them Science Diet, but she doesn't want to continue to have problems with crystals. The cats were first eating Chicken Soup when Hiro developed crystals, and then after those were cleared up, she tried them on Wellness. So far no more problems for Hiro, but Aki then developed crystals, and a whole lot of them too. They get some wet food in their diet, but probably not enough. 
The vet she's taken them too the last few times thinks SD is the greatest food ever and insists that a cat should never eat anything else if you want it to be healthy (apparently according to her, foods like Wellness and Innova are "crap" and dry food is far better than wet... :roll: ) Anyone have any good suggestions for vets in the Madison, WI area?

I'd like to know what kind of diets people have tried for cats that have had problems with crystals. What has worked and what didn't work? And how do you go about safely trying to switch diet without putting them at risk for another bout of crystals?

so far, some of the things I've found out are:
An all wet diet will help to prevent crystals because the extra water dilutes the urine.

When a cat eats, it causes a temporary rise in the pH of their urine. When the urine becomes alkaline, thats when crystals form, so it is better to feed only once or twice a day rather than allowing a cat to graze all day long, that way a rise in urine pH happens only once or twice a day, not all day long.

A raw food diet is thought to be even more effective at preventing crystals.

There are types of cat litter that change color when urine is becoming alkaline. I wonder if using this litter is a reliable way to detect if a cat may start developing crystals again? Maybe it would be an effective way to monitor them while trying to switch diet?

Stress and obesity are also thought to be contributing factors to the development of crystals... I can understand stress as a cause, but I'm not sure how obesity might contribute... any ideas?

I haven't heard about the distilled water idea, but it seems like a good idea and it definately wouldn't hurt to try it.


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## coaster (Dec 1, 2004)

Nell said:


> Tim, have you had luck finding it around this area or would it have to be ordered online?


That's the brand my vet carries (RC), and I was able to find the other three brands locally, so Twinkie got to try them all.


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## OrangeJulius (Aug 23, 2006)

*obesity*

What I got from my vet was the cat was obese from a dry food diet, also not a good diet for crystals. I don't know of obesity itself causing crystals.


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## morea (Feb 8, 2005)

thank you so much for the feedback so far!

My vet must have put Martell directly on the maintenance diet instead of the one that is supposed to dissolve the crystals. I have had a really hard time finding a vet that knows much about nutrition at all. 

The Hills Diet that he is on right now looks awful to me, from a nutrition standpoint. I'll have to look into some of the other brands you mentioned and see what's available around here.

It really bothers me to learn that the food my vet prescribed isn't "right" - not only didn't it get rid of the crystals, but it might have made the problem worse. According to this article (which I found posted in another thread here on cat forum):



Jean Hofve said:


> There are lots of diets and treatments out there. An individually tailored treatment program is needed for each patient. But, if I had only one rule I could make for all of them, it would be "no dry food."


It is so frustrating!

What scares me is that my vet told me that Martell could have flare ups of this his whole life long, and that I will constantly have to worry that he might become blocked. Now, from the research I have done (here and elsewhere) it sounds like this condition can be controlled pretty effectively, and isn't an automatic death sentence. Is that right?


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## coaster (Dec 1, 2004)

I'd agree with that.


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## morea (Feb 8, 2005)

ugh, these are the ingredients in Royal Canin canned food:

WATER, MEAT BY-PRODUCTS, CHICKEN BY-PRODUCTS, ANIMAL FAT (PRESERVED WITH BHA/BHT), NATURAL FLAVORS, TRACE MINERALS (SODIUM TRIPOLYPHOSPHATE, CALCIUM SULFATE, POTASSIUM CHLORIDE, CALCIUM CARBONATE, MAGNESIUM SULFATE, MANGANESE SULFATE, ZINC SULFATE), GUAR GUM, CARRAGEENAN, CAROB GUM, TAURINE, VITAMINS (CHOLINE CHLORIDE, DL-ALPHA TOCOPHEROL ACETATE [SOURCE OF VITAMIN E], VITAMIN D3 SUPPLEMENT, THIAMINE MONONITRATE [VITAMIN B1], PYRIDOXINE HYDROCHLORIDE [VITAMIN B6], FOLIC ACID), DL-METHIONINE.

I had read (in Anita Kelsey's book 'The New Natural Cat' as well as in this 20 page pdf "Cat Food Uncovered") 

"Butylated hydroxytoluene (BHT)
used as a preservative to stop fat going rancid. It has been implicated as a cause of bladder and thyroid cancer and damage to the liver.

Butylated hydroxyanisole (BHA) 
also used as a preservative to prevent fat rancidity. Has been implicated as a cause of stomach cancer."


I have always tried to avoid any cat food or cat treats that contain these preservatives...


The dry food ingredients look better (to me):

CHICKEN MEAL, RICE, CORN GLUTEN MEAL, GROUND CORN, CHICKEN FAT, NATURAL FLAVORS, CELLULOSE POWDER, SODIUM CHLORIDE, DRIED BREWERS YEAST, DRIED EGG POWDER, POTASSIUM CHLORIDE, CALCIUM SULFATE, MONOSODIUM PHOSPHATE, CHOLINE CHLORIDE, CALCIUM CARBONATE, TAURINE, DL-METHIONINE, VITAMINS [DL-ALPHA TOCOPHEROL (SOURCE OF VITAMIN E), NIACIN, BIOTIN, RIBOFLAVIN (VITAMIN B2), D-CALCIUM PANTOTHENATE, PYRIDOXINE HYDROCHLORIDE (VITAMIN B6), THIAMINE MONONITRATE (VITAMIN B1), VITAMIN B12 SUPPLEMENT, VITAMIN A ACETATE, VITAMIN D3 SUPPLEMENT, FOLIC ACID], TRACE MINERALS [ZINC OXIDE, FERROUS SULFATE, COPPER SULFATE, MANGANOUS OXIDE, SODIUM SELENITE, CALCIUM IODATE], PRESERVED WITH NATURAL MIXED TOCOPHEROLS, ROSEMARY EXTRACT, AND CITRIC ACID.

preserved with tocopherols - that's vitamin E or something, no? And no by-products?


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## Meeble (Nov 15, 2006)

my cat had emergency surgery for a blockage last night and they sat me down this morning at the emergency vet and then my regular vet to go over a prescription diet for him in a day or so when he comes home.

When I asked about the multiple cat household and the hills diet prescribed food, both vets stated it was ok for all the cats to eat that since the ingredients were better for them than your typical off the shelf food at the pet or grocery store. The ER vet, whom in two visits really impressed me with her knowledge off the cuff and advice vs my current vets, had said she's never heard of a case of bad side effects from the other cats being put on the same food. That bein said when I investigate online I find some of the similar cases you stated above. Its scary the more I read, the less I feel I know on the subject from all the differing opinions.


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## coaster (Dec 1, 2004)

morea - but the dry food has grains in three forms among the top ingredients, two of the corn. And corn causes more problems as an allergen in cats' diets. Furthermore, carbohydrates (grains) form alkaline urine.

Remember, you only have to feed the urinary formula until the crystals are dissolved, then you can switch to something that's better nutritionally.

DanaK - thanks for the validation from an "authoritative" source. :lol:


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## morea (Feb 8, 2005)

DanaK said:


> Its scary the more I read, the less I feel I know on the subject from all the differing opinions.


that's exactly how I feel! It sure IS scary! It doesn't help that I can't seem to get a consistent answer out of VETS. <sigh>

Thank you for the info!

To everyone who was thinking about the distilled water:

I checked with a nutritionist about giving distilled water to the cats (not a pet nutritionist, a people nutritionist). She thought I was crazy at first, but I did manage to get an answer out of her:

what she said is that there are some essential minerals in regular water that we need to maintain health. She doesn't recommend long term use of distilled water, as it could have adverse side effects. She said that for temporary use for a specific problem it should be ok, but she could not advise giving it on a long term basis.

I researched the different cat foods that are "prescribed" for FLUTD with interesting results. I will post them in a second. 

Tim, thank you for pointing that out... I am still (admittedly) new to studying the nutrition of pet food and how it affects cats. It seems really hard to find a definitive answer to many of my questions.  

My vet had told me that I needed to feed the prescription food every single day for the rest of Martell's life, and that if I gave him something else - even for a day or two - it could result in him becoming totally blocked and requiring emergency surgery. 8O I think that she may have been trying to scare me, or else that she doesn't really understand this condition... given the fact that she handles exotics (birds, reptiles, wild cats kept as pets) in addition to regular small animal practice, I wonder if she is the best person to be asking about this. <sigh>

Regardless, I need to find a new vet here, anyway, because my recent move has placed me almost 300 miles away. It seems that every vet I call has different advice, and I just wish I knew what the best thing to do would be.


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## morea (Feb 8, 2005)

here is what I found when I researched the ingredients of the different FLUTD diets out there. (Royal Canin is listed above)

*Eukanuba (Iams) dry*: Corn Grits, Chicken Liver, Chicken By-Product Meal, Chicken, Dried Egg Product, Fish Meal (source of Fish Oil), Brewers Rice, Chicken By-Products, Dried Beet Pulp (sugar removed), Chicken Fat (preserved with mixed Tocopherols, a source of Vitamin E, and Citric Acid), Natural Chicken Flavor, Potassium Chloride, Calcium Carbonate, Brewers Dried Yeast, DL-Methionine, Choline Chloride, Salt, Zinc Oxide, Vitamin E Supplement, Manganese Sulfate, Niacin, Ascorbic Acid, Copper Sulfate, Vitamin A Acetate, Calcium Pantothenate, Biotin, Rosemary Extract, Thiamine Mononitrate (source of Vitamin B1), Pyridoxine Hydrochloride (source of Vitamin B6), Vitamin B12 Supplement, Riboflavin Supplement (source of Vitamin B2), Vitamin D3 Supplement, Inositol, Potassium Iodide, Folic Acid, Cobalt Carbonate 


*Eukanuba (Iams) canned*: Water, Chicken Liver, Chicken, Brewers Rice, Whitefish, Chicken By-Product Meal, Dried Egg Product, Dried Beet Pulp (sugar removed), Fish Oil (preserved with Ethoxyquin), Calcium Carbonate, Potassium Chloride, Brewers Dried Yeast, Taurine, Tricalcium Phosphate, DL-Methionine, Salt, Choline Chloride, Vitamin E Supplement, Zinc Oxide, Manganese Sulfate, Copper Sulfate, Niacin, Thiamine Mononitrate (source of Vitamin B1), Calcium Pantothenate, Biotin, Pyridoxine Hydrochloride (source of Vitamin B6), Vitamin B12 Supplement, Riboflavin Supplement (source of Vitamin B2), Potassium Iodide, Folic Acid, Menadione Dimethylpyrimidinol Bisulfite (Vitamin K3) 


links and ingredients listed for LOW pH food... also available in moderate pH. http://us.iams.com/iams/en_US/jsp/IAMS_ ... pageID=CVD

____________________________________

Purina vet diets

*Purina (Dry)*
Corn gluten meal, chicken, poultry by-product meal, brewers rice, whole grain corn, oat fiber, wheat gluten, animal fat preserved with mixed-tocopherols (form of Vitamin E), salt, phosphoric acid, dried egg product, calcium carbonate, brewers dried yeast, potassium chloride, animal digest, fish oil, tetra sodium pyrophosphate, choline chloride, taurine, zinc sulfate, Vitamin E supplement, ferrous sulfate, manganese sulfate, niacin, Vitamin A supplement, calcium pantothenate, thiamine mononitrate, copper sulfate, riboflavin supplement, Vitamin B-12 supplement, pyridoxine hydrochloride, folic acid, Vitamin D-3 supplement, calcium iodate, biotin, menadione sodium bisulfite complex (source of Vitamin K activity), sodium selenite. 

*Purina (Canned)*
Meat by-products, liver, chicken, water sufficient for processing, poultry by-products, brewers rice, calcium gluconate, oat fiber, guar gum, sodium bisulfate, potassium chloride, caramel color, carrageenan, salt, taurine, Vitamin E supplement, calcium phosphate, zinc sulfate, thiamine mononitrate, ferrous sulfate, manganese sulfate, Vitamin A supplement, pyridoxine hydrochloride, copper sulfate, niacin, Vitamin B-12 supplement, riboflavin supplement, calcium pantothenate, menadione sodium bisulfite complex (source of Vitamin K activity), Vitamin D-3 supplement, folic acid, potassium iodide, biotin. 
____________________________________

Hills C/D formula is for Feline Lower Urinary Tract Disease, Struvite crystals (probably the maintenance formula?) 

*Hills Feline C/D canned*: Beef By-Products, Water, Pork Liver, Ground Whole Grain Corn, Pork By-Products, Corn Gluten Meal, Calcium Sulfate, Powdered Cellulose, Choline Chloride, Xanthan Gum, Locust Bean Gum, Iodized Salt, Potassium Chloride, Iron Oxide, Taurine, Brewers Dried Yeast, Dicalcium Phosphate, Vitamin E Supplement, Thiamine Mononitrate, Ascorbic Acid (source of vitamin C), Zinc Oxide, Ferrous Sulfate, Beta-Carotene, Niacin, Manganous Oxide, Copper Sulfate, Pyridoxine Hydrochloride, Calcium Pantothenate, Vitamin B12 Supplement, Riboflavin, Biotin, Vitamin D3 Supplement, Calcium Iodate, Folic Acid, Sodium Selenite. 

*Hills Feline C/D chicken canned*: Pork By-Products, Water, Pork Liver, Chicken, Chicken Fat (preserved with mixed tocopherols and citric acid), Rice, Oat Fiber, Ground Whole Grain Corn, Corn Starch, Corn Gluten Meal, Guar Gum, Calcium Sulfate, Dicalcium Phosphate, Calcium Carbonate, Potassium Chloride, Choline Chloride, DL-Methionine, Iodized Salt, Taurine, Vitamin E Supplement, Brewers Dried Yeast, Thiamine Mononitrate, Ascorbic Acid (source of vitamin C), Zinc Oxide, Ferrous Sulfate, Beta-Carotene, Niacin, Manganous Oxide, Copper Sulfate, Pyridoxine Hydrochloride, Calcium Pantothenate, Vitamin B12 Supplement, Riboflavin, Biotin, Vitamin D3 Supplement, Calcium Iodate, Folic Acid, Sodium Selenite. 

*Hills Feline C/D dry*: Brewers Rice, Chicken By-Product Meal, Corn Gluten Meal, Pork Fat (preserved with mixed tocopherols and citric acid), Chicken Liver Flavor, Potassium Chloride, Choline Chloride, Calcium Carbonate, Calcium Sulfate, Iodized Salt, Vitamin E Supplement, vitamins (L-Ascorbyl-2-Polyphosphate (source of vitamin C), Vitamin E Supplement, Niacin, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Riboflavin, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Folic Acid, Vitamin D3 Supplement), Taurine, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite), preserved with BHT and BHA, Beta-Carotene. 

Hills S/D formula for struvite stones and crystals (appears to be the dissolution formula?) 

*Hills Feline S/D canned*: Beef By-Products, Pork Liver, Water, Chicken Fat (preserved with mixed tocopherols and citric acid), Ground Whole Grain Corn, Rice, Powdered Cellulose, Calcium Carbonate, DL-Methionine, Potassium Chloride, Vitamin E Supplement, Iron Oxide, Iodized Salt, Taurine, Thiamine Mononitrate, Zinc Oxide, Ferrous Sulfate, Pyridoxine Hydrochloride, Beta-Carotene, Niacin, Calcium Pantothenate, Vitamin B12 Supplement, Manganous Oxide, Copper Sulfate, Riboflavin, Biotin, Folic Acid, Calcium Iodate, Vitamin D3 Supplement, Sodium Selenite. 

*Hills Feline S/D dry*: Brewers Rice, Chicken By-Product Meal, Pork Fat (preserved with mixed tocopherols and citric acid), Corn Gluten Meal, Dried Egg Product, Calcium Sulfate, Chicken Liver Flavor, Choline Chloride, Potassium Chloride, DL-Methionine, Iodized Salt, Vitamin E Supplement, vitamins (Vitamin E Supplement, Niacin, Thiamine Mononitrate, Pyridoxine Hydrochloride, Calcium Pantothenate, Riboflavin, Vitamin A Supplement, Biotin, Vitamin B12 Supplement, Folic Acid, Vitamin D3 Supplement), Taurine, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite), preserved with BHT and BHA, Beta-Carotene.


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## Meeble (Nov 15, 2006)

well I think the distilled water talk comes from some of the discussion I've seen over cystitis.

Basically what I have read is the membrane to the bladder/kidneys filters out a lot of harmful minerals and the like. For some reason cats, and in some cases humans, the membrane doesn't always filter correctly. sometimes this can be attributed to inflammation or infection, which is why in some cases antibiotics can help the cats. The low mineral diets and distilled waters put less minerals in the cats system, which logically imo puts less minerals strained against that membrane and in theory (if I understand it all correctly), is beneficial from that perspecitve? The other side of the coin is many of those minerals can also assist in the breaking down of certain compositions and constant lack of them risks the other sceanrio of the calcitite(sp?) stones.

I have probably 50 bookmarks from all over the place from a frenzied night 2 weeks ago I can sift through


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## Meeble (Nov 15, 2006)

this was one of the most informative pages I had found:
http://www.vetinfo.com/cflutd.html


::*disclaimer*:: I have no idea the quality of vetinfo.com or the VetInfo digest. Also note many of the articles were from 2000. I was looking for a general background and any advancements in treatment or diagnosis at the time, and a lot of the letters on there I really related to in the _wow thats exactly what I am seeing!_ kind of way.


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## morea (Feb 8, 2005)

thank you for the link, DanaK! 

I wish it wasn't so impossible to get a straight answer on this.


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## morea (Feb 8, 2005)

I would normally take Cornell's word as gospel on this sort of thing, but their website seems to contradict everything else I have read.

http://www.vet.cornell.edu/fhc/brochures/urinary.html

http://www.vet.cornell.edu/fhc/brochures/feedcats.html

Cornell says: "Diet influences urinary pH. For example, when dry food is available to a cat "free choice," the cat's urine pH decreases.... Feed small meals on a frequent basis or feed free-choice dry foods."

Whereas what I keep seeing elsewhere is along the lines of what was stated earlier in this thread: "When a cat eats, it causes a temporary rise in the pH of their urine. When the urine becomes alkaline, thats when crystals form, so it is better to feed only once or twice a day rather than allowing a cat to graze all day long, that way a rise in urine pH happens only once or twice a day, not all day long. "

shoot.


this seems like a good article, too:
http://www.winnfelinehealth.org/health/ ... tions.html


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## coaster (Dec 1, 2004)

This is another good article: http://www.felinefuture.com/nutrition/magnesium.php

Please disregard the Cornell brochure. It's outdated information. My vet gave me that when Twinkie had crystals and then at the follow-up appointment I pointed out what that brochure said and she was astounded. :roll:

And here's a good post about acid-base balance: http://www.catforum.com/viewtopic.php?p=208171#208171

Regarding distilled water, commercial cat food is pretty heavily supplemented, including minerals. I don't think you have to worry about it too much.


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## coaster (Dec 1, 2004)

morea said:


> I wish it wasn't so impossible to get a straight answer on this.


I understand that ... I thought it was all pretty confusing at first, too. But it sorts itself out after awhile. :wink:


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## morea (Feb 8, 2005)

thanks again, Tim... I guess I just need a little hand-holding with all this. 

I just re-read the excerpt from "The New Natural Cat" which reads, "Recent studies have revealed that every time a cat smells food his urine becomes more alkaline."

That seems to be the majority opinion in everything I have seen so far. One dilemma solved...


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## Nell (Apr 7, 2005)

I've been doing some reading of abstracts of different studies involving struvite crystals and diet.

Here are some of my findings (its going to be long but I'll try to bold the more relevent info for easier reading):


Effects of a high-protein diet versus dietary supplementation with ammonium chloride on struvite crystal formation in urine of clinically normal cats. Am J Vet Res. 2003

Laboratory of Nutrition, Azabu University School of Veterinary Medicine, 1-17-71 Fuchinobe, Sagamihara 229-8501, Japan.

OBJECTIVE: To evaluate the effects of a high-protein diet versus dietary supplementation with ammonium chloride (NH4Cl) on struvite crystal formation in the urine of clinically normal cats by measuring the urine concentration of hydrochloric acid (HCl)-insoluble sediment, urine pH, struvite activity product (SAP), number of struvite crystals in urine, and urine volume. ANIMALS: 23 healthy adult cats. PROCEDURE: Urine was fractionated by centrifugation with subsequent extraction of the sediment with 1 N HCl (study 1). Diets containing either 29% crude protein or 55% crude protein were fed to cats in a crossover trial of 3 weeks/period (study 2). Diets supplemented with either sodium chloride (NaCl) or NH4Cl were fed, by use of a 3 x 3 Latin-square design with 3 wk/period (study 3). In studies 2 and 3, urine samples were collected for the last 7 days of each period. RESULTS: The HCl-insoluble sediment contained Tamm-Horsfall glycoprotein (THP; study 1). The high-protein diet (study 2) and dietary supplementation with NH4Cl (study 3) resulted in a decrease in urine pH, SAP, and the number of struvite crystals in urine. However, the high-protein diet decreased urine concentrations of HCl-insoluble sediment containing THP (study 2), in contrast to the NH4Cl supplementation that increased urine volume without a significant effect on the urine concentration of the HCl-insoluble sediment (study 3). *CONCLUSIONS AND CLINICAL RELEVANCE: Our results indicate that compared with dietary supplementation with NH4Cl, the high-protein diet is preferable as a urine acidifier for the prevention of struvite crystal formation in clinically normal cats.*

PMID: 12926602 [PubMed - indexed for MEDLINE]


Evaluation of effects of dietary carbohydrate on formation of struvite crystals in urine and macromineral balance in clinically normal cats. Am J Vet Res. 2004

Laboratory of Nutrition, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Sagamihara 229-8501, Japan.

OBJECTIVE: To evaluate effects of dietary carbohydrate on urine volume; struvite crystal formation; and calcium, phosphorus, and magnesium balance in clinically normal cats. ANIMALS: 21 healthy adult cats (15 sexually intact males and 6 sexually intact females). PROCEDURE: Diets containing no carbohydrate source (control diet), control plus starch, or control plus fiber were given in a 3 X 3 Latin-square design. The diets were available ad libitum in study 1 (n = 12) and given under restrictions in study 2 (9) to equalize daily intakes of crude protein among the 3 groups. Formation of struvite crystals and balance of calcium, phosphorus, and magnesium were measured. *RESULTS: Urine volume was lower in the starch group and fiber group in study 1, whereas no differences were detected among the groups in study 2. Urinary pH and struvite activity product were higher in the starch group in both studies, and the fiber group also had higher struvite activity product in study 2. In both studies, urinary concentrations of HCl-insoluble sediment were higher in the starch group and fiber group. In the fiber group, a net loss of body calcium, phosphorus, and magnesium was detected in study 2. CONCLUSIONS AND CLINICAL RELEVANCE: Starch and fiber in diets potentially stimulate formation of struvite crystals. Hence, reducing dietary carbohydrate is desirable to prevent struvite urolith formation. In addition, a net loss of body calcium, phosphorus, and magnesium during feeding of the fiber diet suggests that dietary inclusion of insoluble fiber could increase macromineral requirements of cats.*

PMID: 14974568 [PubMed - indexed for MEDLINE]


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## coaster (Dec 1, 2004)

Well, so those scientific studies verify what the holistic veterinarians have been saying all along. Thanks for the references -- I'm going to bookmark them.


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## morea (Feb 8, 2005)

great! Thanks Nell!


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## nanook (Jun 12, 2005)

Wow, one day gone and I've missed so much! So, I'll jump in with my 2 cents now.  


> Please disregard the Cornell brochure. It's outdated information.


Absolutely agree!
Firstly, if I read your origonal post correctly, you were feeding W/D instead of C/D. W/D is not for crystals it's for weight loss and is probably not at all good for crystals. So whatever you do, I'd get him off that right away.
A lot depends on how severe the illness was as to whether he needs to be on a prescription diet or not. When my guy had crystals we were lucky and caught it very early. My vet said to put him on a good quality, WET food ONLY. He said a prescription diet wasn't necessary for him. We did talk about it, however, ('cause I'm always full of questions at the vets. :roll: ) and he said, some cats do need to be on a prescription diet for a short period of time (to disolve the crystals- by the way, it is S/D to disolve and C/D to maintain) but it's rare that they need to remain on them, provided they have a healthy, wet food only diet. He said 70% of cats will reblock if they go back to dry food as opposed to 30% of cats that eat wet only. I thought that was interesting.
I know exactly how you feel when you say, the more you read the more confusing it all gets. So true! But, I think it's the very best thing you can do. The sad fact is, many vets have not kept up on the most recent info and most don't know anything about nutrition (my wonderful vet included, but at least he admits it! And, although he hasn't studied actual nutrition, he makes it a point to keep up on the newest findings. That's a huge plus.)
So, for what it's worth, here are my conclusions so far:
Once kitty is stable (free of crystals)
1)Feed a WET ONLY good quality, high protein, low or no grain, low carb diet. Reason? High protein diet causes more acidity naturally and more moisture in the diet seems to be a very important factor.
2)Mealtimes and picking up all food between. Mine get fed 3x per day. Reason? Having small periods of fast between meals causes the system to become slightly more acidic. It also gives the body time to put energy into other things besides digesting food which is all around better for their immune system.
3)Bottled water not tap (for me the jury is still out on long term distilled) Reason? Among other things, tap water tends to have things like chlorine and flouride which cats can not asimilate. Several recent studies have shown possible links between abdominal cancers (majorly on the rise in cats) and chlorine. Yikes!
Everyone has given you some great links regarding diet. If you haven't already, check out the sticky at the top which has even more.
From everything I've read and seen, the above just makes sense. 
Do you have any teaching hospitals in your area? If so, they are a great resource and you may fine a terrific vet through them but, it does sound like you may be better off changing vets.
Hope that that helps and your kitty is soon crystal free!


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## morea (Feb 8, 2005)

thanks nanook... I had Martell on C/D all summer (and September was when he had his last urinalysis, showing that he still had crystals. 

For the past month he and the other two cats have been eating W/D.

Tonight, I spoke to a local vet and brought home cans of Hills S/D. I talked to the vet tech about it (as the vet had gone home for the night), and she believes that this is the best course of action at this point... feeding Martell the S/D and the other cats a high quality wet food. 

He isn't currently displaying any symptoms - he uses the litter box regularly but not frequently, doesn't seem to strain at all, I haven't noticed any discomfort or blood in his urine, he is playful and he seems fine... but the vet assures me that he still has the crystals, and I want to stay on top of this so he doesn't have any pain or suffering, if that is possible. 

I already feed in the morning and evening and remove food in between. 

I purchased a jug of distilled water which should last about a month and only cost a few dollars.

In 6 weeks (after being on the S/D for a while) Martell will have his next urinalysis, and we will go from there. 

I'll check into teaching hospitals. I actually called the local SPCA for advice on local vets, but they told me that they are not allowed to recommend one over another. It's extra hard, because I am in Quebec, and I am not very proficient in french. I also don't know any other pet people I can ask for recommendations, but I have talked to a few different veterinary offices and I believe that the one I visited tonight looks good. 

I will definitely keep checking back here, both for advice and to share anything I learn in the process. Thanks so much to everyone who has posted about this... it has been very helpful!

Oh, and here are some photos of Martell, for anybody who is interested:
http://www.catforum.com/viewtopic.php?t=37289


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## coaster (Dec 1, 2004)

morea said:


> ... but the vet assures me that he still has the crystals, ...


Just wanted to throw in that it's _normal_ for a cat to have some crystals in a urine sample. It's just when they get too numerous, too large, or form into clumps or stones large enough to block. In addition to blockages, crystals irritate the bladder wall, causing cystitis and bleeding. I guess what I'm saying is that if your vet says he still has crystals maybe a good follow-up question is: is it still a problem? That, I think, is a matter of subjective interpretation on the vet's part. I asked my vet if there was some kind of way to measure the crystal density and if so, what the acceptable ranges were. She said no. So I think the vet goes more on whether or not any symptoms are presenting, along with measurements of urine pH and specific gravity (which do have "normal" ranges.)


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## morea (Feb 8, 2005)

*smacks forehead*

she never told me that... but she DID still seem concerned. Thank you for clarifying. I had no idea. 8O


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## morea (Feb 8, 2005)

another article; it shows copyright 2000, but looks pretty up to date.

http://www.marvistavet.com/html/the_non ... d_cat.html


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## morea (Feb 8, 2005)

has anybody here heard of this food?

http://www.medi-cal.ca/consumers/Feline ... ge2_EN.asp


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## morea (Feb 8, 2005)

Martell has seemed a lot better... he only has another week or so until he has to have his next urinalysis to see if the crystals have cleared up. He has had a great appetite for that Hills s/d - until today.

I can't think of anything that changed, but this morning he has thrown up twice so far - a yellow/orange colored liquid that I assumed was bile or something. I am not aware of him eating anything he shouldn't have and he has not come into contact with any other cats since these guys are indoor only. He also refused his breakfast, and in the whole time I have known Martell, he has NEVER refused food.

I am worried that he doesn't seem to be feeling well, and I worry about everything that I have read about him possibly becoming blocked. I haven't seen him straining in the litter box and he hasn't been peeing outside of the box either, so I am keeping a close eye on him.


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## morea (Feb 8, 2005)

over the course of the last hour, both of his eyes have filled up with a mucousy looking yellow-brown substance. 

I called the vet and they said he probably has a cold and that I should watch him but I didn't really need to worry about it. 

He feels warm and he is listless and not eating. 

I called another vet for a second opinion, and they said it was probably a cold (where would he get a cold without getting near another animal?) but that they would look at him if I was worried. 

Since neither vet seems worried, should *I* be this worried? I am not working right now, so another $50 exam 2 weeks after his yearly is not something I really WANT to spend, but if there is reason to be concerned, I will get him right in. 

What would you guys do?


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## CataholicsAnonymous (Dec 4, 2006)

Although I can truly understand the financial implications, "warm, listless, and not eating" are critical signs. I'm afraid I would get him to a vet as soon as I could. 

I worry that neither vet seems concerned about him, especially considering his history.


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## morea (Feb 8, 2005)

that concerns me too. We are going to call other vets.

He isn't eating TODAY... he normally has a huge appetite, but he has only skipped one meal, breakfast today. He is also overweight thanks to Hills s/d. He could stand to lose two pounds (and I am sure he will once he is back onto a high quality food) but I heard that fasting an overweight cat can result in liver problems, so I don't want him to go without eating if I can help it.

He only threw up the twice, and it has been a few hours. He isn't throwing up any more. He is sleeping on his pillow.

I cleaned his eyes carefully and they are still a little goopy, but they haven't filled back up. I wonder if that could be because he climbed up into the box spring under the bed this morning and got some dust in his eyes. 

I did read that discharge from the eyes can be due to an infection in his gums. The vet mentioned that he could use a dental cleaning, but she didn't seem to think it was a rush, she just told me to consider it. We have been waiting until we did his next urinalysis, which is due around the 16th this month. I think that the dust is the likely culprit, but I don't like to take chances. 

He seems warm to ME around his ears, but I might be imagining it because I worry about him. I have an appointment set up for 6pm, and have put him into his own room with his own litterbox away from the other cats. 

Hopefully it will turn out to be nothing... just another "peace of mind" vet visit. I just hate taking him out into the cold and stressing him like that if it is really nothing to worry about.


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## coaster (Dec 1, 2004)

I hope it's just a stomach "bug"


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## morea (Feb 8, 2005)

well, he DID just use the cat box and he is up and around. 

He is acting better already, but I am still keeping a close eye on him. The vet suggested no food for 12 hours after he threw up to allow the virus (if that is in fact what it is) to pass.

His eyes look a lot better, and he is sitting here staring at me expectantly... I think he wants to eat. I am going to give him just a small amount of food and see how he does with it, because right now he just tried to stalk and kill the pizza his dad is having for lunch. :lol: 

I have a terrible tendency with these guys to fear the worst. I don't want to miss something and have them get REALLY sick. Of course, it gets expensive to run to the vet every time I worry something is wrong.

*whew* 

Hopefully this was just me overreacting. Fingers crossed!


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## CataholicsAnonymous (Dec 4, 2006)

> just another "peace of mind" vet visit


Oh, dear, the money I've spent on _those_ visits! I can't count the times I've gone in and the vet asks, "Well, what's wrong with your cat?" And I say, "You know, something's wrong......I can't quite put my finger on it......but he's just not quite 'right'......" Or the time's I've said, "Just humor me, and let's test him for 'XYZ disease' or metabolic disorder or whatever." I can hear their minds going "Ka-ching! Ka-ching!"

One vet (whom I no longer use) once complained, "You know, you bring these cats in before they show any real symptoms --- you make it impossible to diagnose." Guess he didn't need the money  

And I wonder why I'm broke and in debt :?


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## morea (Feb 8, 2005)

Martell has been on Hills s/d for 6 weeks, and we took his urine specimen in today to make sure everything was ok... 

it turns out that he still has some struvite crystals, but now he also has the OXALATE crystals, and has to go on another prescription diet for another 6 weeks! (Royal Canin Urinary SO is what the vet gave us.)

I can't believe it, he isn't showing any symptoms, and I thought he was going to be all better... and now this, which sounds a lot worse than the struvite crystals. Ugh!

I have read in several places that oxalate crystals have to be removed surgically, not dissolved... does anybody have information about these?


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## morea (Feb 8, 2005)

I read this tonight, does anybody know if there is any truth to it?

"As you mention, Oxalate stones are becoming a more prevalent problem in Feline Lower Urinary Tract Disease (FLUTD) . Even though oxalate stones are not as common in this disease, some diets do contribute to this problem. The diets that cause an acidic urine such as most of the prescription foods for FLUTD which address struvite crystals and stones, promote the formation of oxalate crystals and stones since oxalates need an acidic environment to develop. 

Oxalate crystals/stones develope in only 5-10% of the cats with FLUTD and may not even be this high. This is fortunate because the treatment for these stones is different than for struvite crystals. There is one prescription diet that supposedly addresses this problem, it is Select Care Control diet. It is available from only a limited number of veterinary hospitals. You would need to check around to locate it. 

The other option is for the cat to be placed on a commercial or prescription diet, and to add Potassium citrate to the diet. This is a liquid that can deactivate the oxalates and prevent the stone formation. It must be given on a daily basis, but seems to correct the problem quite nicely."


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## coaster (Dec 1, 2004)

I can only speculate that the prescription diet caused the urine to become too acidic. But if I remember right, oxylate stones don't form all that quickly. What was found in his urinalysis must have been pretty small crystals, no? So hopefully just a change of diet to produce the correct urine pH will be enough. And the potassium citrate sounds like a fairly simple fix, too.

Maybe you should look into measuring urine pH at home. I remember somebody here does that on a regular basis, but I can't remember who.


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## morea (Feb 8, 2005)

I've been trying to find a way to do that, with no luck. Obviously I will continue to look, but if anybody has any ideas, please let me know.

I don't get how he can have both kinds of crystals now... and everything I read says that the oxalate crystals can not be dissolved and that male cats need surgery to remove them...

And in addition, won't putting him on a food that will raise the pH of his urine cause a resurgence in the struvite crystals!? 

God this is scary.  

I am waiting for the vet to call back.


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## morea (Feb 8, 2005)

this has been a problem since june. My vet at home put him on dry hills c/d and told me that he would have to eat that for the rest of his life, and that going off it for even a day or two could result in him becoming totally blocked. 

Then when I mentioned that he was gaining an awful lot of weight, the vet put him on Hills dry w/d.

In November, the new vet said that he should be on Hills wet s/d for 6 weeks to dissolve the crystals.

Tonight the other vet at the same office asked why he had been put on s/d and said that he will need to be on this Royal Canin Urinary SO for another 6 weeks.

Fortunately for Martell, he seems able to switch from one food to another with no ill effects, but he must be all messed up inside. I am so worried, it seems no matter what I do I still can't get straight answers and I still can't get him over this!


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## OsnobunnieO (Jun 28, 2004)

you can test for pH at home with urine strips, but I don't know how available they are. Some people have mentioned putting any sort of "fake" litter in the box that won't absorb the liquid, like packing foam, unpopped popcorn, etc. They also make a special litter called NoSorb that are just tiny black pellets that you can try (your vet should have some).


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## coaster (Dec 1, 2004)

You know, I'm wondering how the presence of oxalate AND struvite crystals BOTH was diagnosed. They look an awfully lot alike:

















now, which is which? No cheating by looking at the file names. :wink: 

Jessie, can you tell?

I was told that when crystals are observed in a urine sample, whether they were struvite or oxalate was determined primarily by the urine pH. Alkaline: struvite; acidic: oxalate. Obviously, the urine sample can't be both at the same time.


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## morea (Feb 8, 2005)

my thoughts exactly! Thank you, Tim, for expressing it better than I was able to. My brain is more than scattered right now. 8O


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## morea (Feb 8, 2005)

okay, just got off the phone with the vet. Um, this doesn't match up with anything I've heard before. 

She said that the urine pH was 5.5, and the oxalate crystal count was 15. She told me that oxalate crystals form when the urine is acidic, and struvite crystals form when the urine is alkaline.

She wants him on the Royal Canin Urinary SO for 6 weeks, then to do another urinalysis. She had prescribed DRY food, but we requested it in canned, and the girl at the reception desk got the canned for us.

She said that he will need to be on the Royal Canin Urinary SO for the rest of his life, in order to maintain the crystals. 

She said that the condition is not too bad yet, that there didn't appear to be any clumps of oxalite crystals and that since Martell is only about 3 or 4 years old he probably didn't have a stone. (WHAT?!)

She also said that since he is not exhibiting any symptoms, that is another reason not to expect a stone... at least that made more sense. She did say that if he started to exhibit any symptoms that we would need to bring him in for x-rays. 

I told her that I was concerned about feeding him a food long-term that included BHA and BHT, since these had been implicated in stomach, thyroid and bladder cancer, and she said that there is no proof of that, and that he would be in danger of becoming blocked if I took him off this new food.

She said that the potassium citrite was not terribly effective, and was typically given before this particular food was on the market. She insists that this food is more effective. 

She also said that he has oxalate crystals now, not struvites, but that this food will control both types of crystals. 

My head is spinning. I was really hoping to get Martell switched onto the Eagle Pack, but this is the 2nd vet (the first being my normal vet in NY) who has told me that he will need to be on this particular food for the rest of his life. 

Can anybody help to enlighten me please?


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## coaster (Dec 1, 2004)

That pH is pretty acidic. It should be around 6.5, if I remember right. I'd recommend staying on the prescription food until he's got a normal urinalysis, and then switch him to raw.


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## nanook (Jun 12, 2005)

I agree with Tim. I'd do your own research but I know several people who have had a lot of success with various health issues, including chrystals, by switching to raw. I'm still trying but Nanook is terribly stubborn.


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## morea (Feb 8, 2005)

that is what I was thinking, too, Tim. 

I read that optimal pH for a cat's urine is 6.4 to 6.6, so the 5.5 really concerned me. The oxalate crystals also really concern me, since he would have to pass them since they can't really be dissolved, and I understand that a male cat is more likely to block than to pass them!

I really don't want to keep him on this food for the rest of his life. I don't like what it does to him - making him borderline obese at the least, and possibly predisposing him to cancers and liver problems. 

Especially since Tyrael seems to have symptoms of irritable bowel (though I am still not convinced it is irritable bowel, I honestly think that his colitis was triggered by a food allergy) I have been seriously considering a raw food diet. 

The thing is, I am really scared that I will do something wrong and that the cats won't get the proper nutrition, or that I will accidentally mishandle something and that they will get sick. I have read about grinding bones into the food, but I still worry that the bones will somehow hurt them. 

It seems that everywhere I look for information, it only conflicts with the other information I have found. 

And while I am convinced that most vets don't know as much about feline nutrition as they should, I am still scared to go against my vet's instructions. I mean, they have been educated as doctors, and the knowledge that I have only comes from forums, internet searches, and books that conflict with other books. I feel well out of my league. 

I would do anything for these guys, but I am so confused about where to even begin!


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## doodlebug (May 13, 2006)

morea said:


> Especially since Tyrael seems to have symptoms of irritable bowel (though I am still not convinced it is irritable bowel, I honestly think that his colitis was triggered by a food allergy) I have been seriously considering a raw food diet.


There is a difference between Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). IBS is stress related, IBD is an immune response of which one of the mnay causes may be food allergies.


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## manitu22 (Apr 25, 2003)

My Willis had stryuvite crystals before. He went on an all wet diet of Royal Canin S/O. I also was mixing a lot of water in with his food. The vet told me he would probably need to stay on the food for a long time or maybe forever. Well after a couple of months I decided to slowly switch him over to Innova wet and kept mixing the water in and he was fine. Still is to this day.

Good luck to you. Hope he gets better soon.


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## OsnobunnieO (Jun 28, 2004)

ok Tim - purely a guess. The left is the oxalate and the right is struvite?

I'll mention again that I'm not the one that looks at the urine sediment slides... just take a peek when there's something fun.

My understanding though is that most oxalate crystals are on the small square side by struvites come in many shapes and sizes... the ones I always picture are little "stick" looking crystals. I could be wrong though.

I really can't be much more help (and I guess if I was wrong, no help at all!) but I'll toot the raw horn as well... based on what I've heard not my actual experience.

*edit - I couldn't resist... looked up the file names and I WAS right!  *


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## coaster (Dec 1, 2004)

Yup. And the struvite crystals from Twink's sample I got to peek at were rectangular, too.


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## Nell (Apr 7, 2005)

I think this is another case of vets who have only been educated by the pet food companies... "this cat has to be on _this_ food for the _rest of his life_" just sounds to me like a great way to insure the company's future in the pet food market.

Maybe you should look for a holistic vet, as they seem to be the only ones willing to try and get to the root of the problem rather than just try to balance things out with crappy foods and weird additives.

I think a high protien, low carb canned food or a raw food diet is worth a try once the crystals are cleared up.
Normal pH of a cat's urine= 6.5. Ph of a mouse= 6.5.
It just makes so much sense to feed a cat something closer to their natural diet...


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## coaster (Dec 1, 2004)

Well, I agree with you Nell, but the pH of the food source doesn't equate into the pH of the urine. :wink:


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## morea (Feb 8, 2005)

I realize that this new food is supposed to help dilute Martell's urine, and I continued to add some water to it (like I was doing with the s/d) but his nose seems really wet and so does his mouth, almost like he is about to drool all the time. I don't recall him ever looking so "moist".

Otherwise he seems fine, he's acting normal and everything. Is this something that I should be concerned about?


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## coaster (Dec 1, 2004)

I don't think so. Maybe he picked up a little cat cold at the vet?


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## morea (Feb 8, 2005)

I guess that's possible, though I did see them cleaning down the table right before I took him in, and he didn't come into contact with any other animals. I suppose it could have been something airborne.

Hmm, he is acting normally, and doesn't seem so wet any more. I am so paranoid about this whole thing, I've never had a cat with a health problem like this before, and within the past few weeks, this diagnosis and Tyrael's bout with whatever he had sure managed to make me edgy. Maybe he just irritated it sniffing around again. 

I worry so much about these guys.


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## morea (Feb 8, 2005)

Martell and Tyrael both got the cold, and had it for about a day and then it went away. I had called the vet to see if I should watch for anything in particular, and he gave me a list of things to watch for... fortunately, none of them came up.

I did double check with him when I called, he thinks that Tyrael has inflammatory bowel disease, not irritable bowel syndrome.

Martell seems to be gaining weight right before my eyes... I am very concerned about him. He has been on this low quality prescription diet since June and has gained two pounds. Here are some pictures I took tonight of what he looks like:



















aside from trying to get him to play and be active, is there anything I can do to keep the weight down?


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## coaster (Dec 1, 2004)

Feed him less? Or change his name to Snowball? :lol: Sorry, couldn't resist that.  That's kind of surprising as when Twink was on his prescription diet, he actually lost enough weight to concern the vet. There weren't as many calories in it, as I remember. He was on the Royal Canin Urinary SO canned. Isn't that what you're feeding him, too?


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## morea (Feb 8, 2005)

it is what he started on yesterday.

He has been (over the course of the past 6 months) on Hills c/d dry formula, then Hills s/d canned formula, and now the Royal Canin. 

I only feed him half a (5.5 oz) can in the morning and half at night. The vet said "do not exceed 1 3/4 cans a day 8O but she gave no minimum amount.


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