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When a Horse Is Really a Zebra: Unlikely Explanations for Cat Health Problems Can Be Correct

My vet and I believed stress was causing my cat's inappropriate urination; we were both wrong.

JaneA Kelley  |  Jun 7th 2016


There’s an old saying in the veterinary world: “When you hear hoofbeats outside the window, think horses, not zebras.” In case you’re not familiar with this phrase, it means that if an animal is showing symptoms of a problem, the cause is probably not a rare disease but something pretty obvious and simple.

But sometimes you should think zebras instead of horses.

Tara still enjoys spending quality time under the bed, but she's a lot less stressed now!

Even after more than six months, Tara still enjoys spending occasional quality time under the bed.

When my “surprise kitty,” Tara, began showing signs of inappropriate urination, I followed the advice I give readers of my blog and immediately took her to the vet. I wanted to rule out infection as a source of her problems, after all.

I’d learned in a continuing education class at my former employer that it’s pretty rare for cats as young as Tara to get urinary tract infections, but nonetheless, I thought it was worth checking out.

Her first vet, understandably, came from the “horses, not zebras” school of veterinary medicine and figured the cause was behavioral. Tara was new in the family and very stressed from having to deal with two new cats and a radically changed life situation. He prescribed alprazolam to help her deal with the stress.

For a while, it looked like the medication was working.

For a while, it looked like the medication was working.

The alprazolam did help to relieve her stress, and I thought it had stopped the inappropriate urination — until I found some new spots and realized that she was still peeing where she shouldn’t. I went back to the vet clinic and saw the same doctor. He suggested adding fluoxetine, an antidepressant, because that might help her more.

Alas, the urination continued. My house was rapidly becoming a swamp of stink. At the recommendation of another cat lover who had dealt with inappropriate urination issues, I bought a carpet cleaning kit that worked wonders on the stained and malodorous spots I found. Once again, I could sleep free of nasty cat pee smells.

But it was too good to last. Tara was now hiding under the couch, and I soon realized that she was peeing under there. I also found that she’d ruined a cat bed by peeing and pooping all over it.

Thomas and Bella wanted to meet Tara, but Tara didn't want to meet them!

Thomas and Bella wanted to meet Tara, but Tara didn’t want to meet them.

I threw the cat bed away and moved one of my litter boxes to the place where it had been: After all, like celebrity cat behaviorist Jackson Galaxy says, “For every no, provide a yes.”

That didn’t work, either.

This had been going on for almost six months by now. I was getting really frustrated — not with Tara, but with the fact that I hadn’t been able to fix whatever problem was causing her to be so stressed and scared that she wouldn’t pee anywhere but under the couch.

I was starting to wonder whether Tara would ever be able to be happy here, or if she’d do better as an only cat. I didn’t want to give up on her, but I did want to do what would be in her best interest; if that was sending her to a place where she could be the one and only, and that’s what she needed, I’d do it.

I moved the couch to clean up Tara's urine spot, and she promptly hid under the TV console.

I moved the couch to clean up Tara’s urine spot, and she promptly hid under the TV console.

Finally, in desperation, I called my vet again. I asked for an appointment with the vet I usually see, not the one I’d seen twice before, and explained the situation: We’d been treating her problem as if it were a behavioral issue, but even with psych meds on board and all the stress-reducing activities I could think of, she was still peeing inappropriately.

My vet listened to me very carefully. She documented Tara’s symptoms, and she said to me, “Well, it’s not common for cats to have infections, but given that this has been going on for so long and the behavioral course doesn’t seem to have been effective, we should definitely rule out medical problems.”

So Tara went “in the back” with a tech. Staff members took radiographs to see whether she had bladder stones. They drew blood and took a urine sample.

At her most recent vet visit, poor Tara looked kind of scruffy because she hadn't been grooming herself well -- a sure sign of a sick cat!

At her most recent vet visit, poor Tara looked kind of scruffy because she hadn’t been grooming herself well — a sure sign of a sick cat.

My vet returned to the exam room and brought me into the treatment area.

“Her X-rays are normal,” she said, pointing to all the relevant places on the images. “There’s no evidence of bladder stones or any kind of orthopedic trauma. Her hips look great.”

“But,” she said, “there is blood in her urine, so there’s clearly something going on there.”

She said if I could wait a few more minutes she’d take a look under the microscope to see whether she could find any cause for that bloody pee.

There were no crystals in her urine, but the vet thought she’d seen some bacteria — it was hard to tell with all the blood cells in the urine, though. They were going to put some of her urine in a “nutrient soup” and see if more bacteria grew.

I got a call back the next morning: Tara did in fact have a urinary tract infection. We immediately started her on a broad-spectrum antibiotic.

Tara's feeling much better -- and much braver -- now that her UTI has cleared up.

Tara’s feeling much better — and much braver — now that her UTI has cleared up.

Since then, Tara hasn’t peed anywhere except the litter box. She’s been staying in my bedroom while she recovers from her infection, and I’m doing a much more gradual reintroduction of Tara to my other two cats in order to minimize her stress.

The moral of this story is, sometimes when you hear hoofbeats outside your window, it is in fact zebras and not horses. If your cat is suffering from a problem like inappropriate urination or some stubborn behavior issue, don’t be shy about pushing to determine whether the cause is medical, even if your cat doesn’t “fit the profile” of one who would have a medical problem. It’s worth the time and effort – and yes, the expense – of figuring out what’s really going on.