This is Ruthless Bader "Tallulah" Ginsburg:
I found her in a cemetery when she was off in a bad way. I searched for her mother, but she was all by herself. Her tail hung limp, she was leaking fluid from her rear end, and her anus was distended and swollen with maggots and fly eggs. I took her to the emergency vet, got her sorted out, and then brought her home for recovery. She's been with me ever since.
Tallulah has never had much control over her bladder or her bowels. She doesn't normally void, instead she holds onto the urine until it leaks. And her stools are little cannon balls of poo: round and firm (but not hard). The vets she's seen over the years have checked her for an ectopic uterer and other congenital abnormalities, but as far as anyone can tell, her incontinence is a result of some spinal trauma she suffered as a kitten. She can move her tail from side to side, but she can never lift it.
Because of her continence issues, Tallulah suffers from frequent urinary tract infections. Her first urinary tract infection wasn't diagnosed by a veterinarian until she was about six months old and they were going in to spay her. They noticed her bladder was scarred and shriveled, and did a culture, gave her clavamox, and then we were off to the races. Since then, she's had urinary tract infections about every 3 months, or she did until spring of this year (2014). Tallulah had a new infection, each resistant to the last antibiotic she was on, about every month from February to June. If she was given clavamox for the staph infection, her e.coli infection would be resistant to clavamox but not zeniquin. Then when she got another e.coli infection, it would be resistant to zeniquin, not clavamox. Ultimately, her regular team of vets threw up their hands and said there was little that they could do, and that she'd have to see a specialist.
After seeing the specialist in June, Tallulah is now expressed 3 times a day. Once in the morning when I get up for work (6 AM), immediately when I get home from work (5:30-6pm), and then right before I go to bed (10-11pm). So she'll go anywhere from 8 to 10 hours between expressions. She's on cosequin for her bladder health, Crananidin extract (1/4 tablet), and bethanacol (twice daily). We also did acupuncture for about six months, but there wasn't much improvement in her continence and her stress level went through the roof. She's also been on Royal Canin Urinary S/O exclusively for about a year. I bought the veterinary dipsticks to check her pH and blood count in the urine, and I keep a close eye on her behavior as best I can. She's prescheduled for urine cultures every three months (when things go right), but she always seems to come down with something shortly before, or almost immediately after the culture. (Edit: And as of 10/1/2014, she is also a diabetic and will be on insulin and prescription food.)
And yet despite all of our preventative efforts... she's still suffering from infections. After seeing the internist and having a clean bill of health in June and July, she had another infection in August. And then with another clean bill noted less than two weeks ago, she has developed yet another infection (or it may be the same infection). I feel like an utter failure that there's nothing that I can do to stop these infections from happening.
We've come a long way from the scruffy kitten that she was. And yet...she's only two, but she's had over six infections. I'm terrified that she'll become antibiotic resistant and that I'll have to put down my little princess. I want at least twenty years of companionship before I walk down that road.
As soon as she gets her labwork done, I'll schedule a meeting with her internist to discuss a plan of action. I know there are drugs on the table that are supposed to turn the urine into formaldehyde, and there's also antibiotic pulse therapy... but has anyone had any success with these treatments? With other treatments? Other supplements?
I know it's pointing out the obvious, but expressing every 6 hours also kept the bladder smaller. It was an adjustment, because before I had a paralyzed pet I was in the habit of sitting down to a very nice lunch at the Thai restaurant every day, and that became a permanent thing of the past. But I found I could still get Thai food on the way home after work. You adjust, you figure out ways to make it work. I feel that expressing every 8 hrs (or actually every 6) provided the foundation for bladder health. One thing that made it easier for me in the beginning was remembering a roommate I once had who said she got a bladder infection when she was flying because she didn't want to go to the restroom in the airplane so she simply waited too long, and that was what caused it.