Case study: Clarabell

Clarabell, a 4-year-old female ragdoll mix, came to Chisholm Trail Veterinary Clinic – New Braunfels for her annual wellness visit, including annual vaccines and a preventive health screen. Two years ago, Clarabell was diagnosed with kidney stones, so an ultrasound to monitor her kidneys was part of her plan.

When Clarabell’s screening results came back, her urinalysis showed two to three transitional epithelial cells and blood in the urine, both abnormal findings. These cells originate from the bladder, ureters, and renal pelvis. Her urinalysis showed high protein levels. Dr. Melissa Havemann immediately requested an ultrasound to look for visual abnormalities in the bladder.

Clarabell’s initial scan showing the mass in her bladder, measuring 0.38 cm.

By ultrasound, Dr. Havemann identified a bladder mass measuring 0.38 cm and noted a thickening of the bladder wall. At this point, Dr. Havemann suspected transitional cell carcinoma (TCC), a highly aggressive, malignant form of bladder cancer. However, TCC is rare in felines, and at Clarabell’s young age, Dr. Havemann wasn’t convinced TCC was the correct diagnosis. She ordered a recheck ultrasound in 10-14 days to look for a change in the mass’ size.

At Clarabell’s next ultrasound, the mass had grown to 0.96 cm. With such an aggressive growth rate, Dr. Havemann recommended further diagnostics – a second urinalysis and a urine culture – to rule out other possible diseases.

Clarabell’s next scan showing the mass at 0.96 cm.

Clarabell returned to Chisholm Trail Veterinary Clinic where she was anesthetized and a urinary catheter was placed. The catheter was fed into the bladder and used to exfoliate cells from the mass. Several vials of urine were collected to be analyzed as well.

By this time, the mass had grown to 1.22 cm in size. Clarabell was given convenia (an antibiotic) to combat any bacteria introduced during the procedure. Dr. Havemann also placed Clarabell on a new diet, Science Diet c/d, to combat cystitis, or bladder inflammation. Dr. Havemann requested that Clarabell return in four weeks.

Clarabell’s next scan, showing the mass at 1.22 cm.

Clarabell’s urinalysis and urine culture proved that she was free of bacteria and TCC cells. The only abnormalities were a high protein level and blood in the urine. The mass in her bladder was now suspected to be a blood clot that had adhered to the bladder wall. Dr. Havemann diagnosed Clarabell with chronic cystitis and recommended that Clarabell continue to eat Science Diet c/d.

Feline cystitis is an inflammation of the bladder. It is a common condition, and one that can be very uncomfortable for a cat. It is common in younger felines, with episodes tending to diminish with age. Cystitis is different from bladder infections, bladder stones, or serious urinary tract infections. Episodes of cystitis can be triggered by stress. Science Diet c/d, a prescription diet specifically designed to manage urinary health problems, helped control Clarabell’s cystitis.

One month later, Clarabell’s mass had resolved and her bladder wall was no longer thickened. Her owner reports that she is happy and healthy at home.

Clarabell’s last scan, with no mass.

“Annual bloodwork and health screenings allow us to catch underlying disease early on, which can help prolong a pet’s life,” Dr. Havemann says. “If your pet has kidney disease or abnormalities, bloodwork every 6-12 months, paired with an ultrasound screening, is what I recommend.”