To preface: I've worked as an OTJ-trained tech in a general practice for a year, and I have a B.S. in Animal and Veterinary Science. I have basic knowledge of radiographic interpretation, feline constipation, FLUTD, and urolithiasis.
Signalment: Penny is an 8-year-old F/S DLH, 11.5 lbs.
History: onset of severe constipation 2 years ago; initially treated with daily lactulose. One year ago, she had a life-threatening episode that required three sedated manual de-obstipations within one month. She began Cisapride 5mg BID, MiraLAX 1/2 tbsp SID, liquid gabapentin 50mg SID, and cetirizine 5mg SID, and she has been stable on this combination since. Six months ago, she developed a UTI and concurrent cystitis, which was effectively treated. She has seasonal allergies (hence, the cetirizine) and a tendency of overgrooming, and I suspect hair accumulation contributes to her constipation.
I noticed decreased stool output and occasional straining over the last week, so I administered an at-home saline/lactulose enema, which didn't appear to help. On Saturday, I brought Penny to a local emergency clinic for radiographs to rule out obstipation. She was not blocked, so no treatment was required, and we were sent home. The veterinarian had concerns about reduced gut motility (which we already knew) and recommended future surgical intervention if her current treatment fails.
The clinic emailed me her radiographs for my own record-keeping; I glanced at them once we got home, and I immediately saw what appeared to be a bladder stone and additional sediment in the bladder. The veterinarian we saw reported no obvious abnormalities in her radiographs (apart from colonic distension), and I'm not an expert by any means, but I was definitely concerned about an oversight. I called back and asked for the veterinarian to take another look and either confirm or deny my suspicion. I finally heard back from them two days later, and their response was "yep, definitely a bladder stone, she needs to get that checked out."
I know the next steps are urinalysis and ultrasound. She had both of these done three months ago; the urinalysis was negative for crystals, and the ultrasound showed moderate thickening of the bladder wall, consistent with cystitis, but no sediment or stones were observed.
My biggest question is: Does this need to be addressed right now? The stone is unobstructive, and she has no urinary symptoms. It's just one new problem after another with Penny, and I feel like I'm constantly trying to get one step ahead of things, rather than having them under control. I'm also really frustrated with the emergency clinic; had I not known the basics of interpreting rads, this probably would've gone undiagnosed until it became a problem.
I feel like I'm failing Penny; she's my whole world, and I just want her to be comfortable and happy. I'm looking for any insight into her radiographs (linked below), managing her conditions, and possible next steps. Thank you so much!
Lateral radiographs (4/25/26) linked here
Lateral + VD radiographs: link to post