I'm not sure where milessmith is getting his information. I can say that the veterinary experts who wrote the 2011 AAHA Canine Vaccination Guidelines (which is used as the standard in N American veterinary medicine) would NOT recommend a Bordetella bronchiseptica vaccine be given ROUTINELY to dogs every six months.
One of the co-authors of those Guidelines, who lectures at vet CE conferences regularly on vaccination protocols, Dr Richard Ford (emeritus at NC State vet school), is a friend and mentor to me. I have listened to many of his talks, read many of his published articles and talk to him often about vaccinations. I can't speak for him, but he feels I have a good understanding of the issues.
1. Bordetella bronchiseptica (Bb) is a NON-Core vaccine ... which means that it is only recommended if a dog has a known high risk of exposure, e.g. about to be boarded at a kennel, regular time in a dog park, dog shows, etc. It is not recommended automatically for all dogs.
2. There are three different types of Bb vaccines ... with three different routes of administration: injectable, intranasal, oral. The immune response and booster intervals differ based on the vaccine used. However, in all cases, studies have shown that the duration of immunity (DOI) is at least a year. Of course, not all dogs respond to vaccines in the same way and there are no guarantees. The AAHA Guidelines recommend boostering "annually or more often in high risk animals".
It is critical that Bb vaccines be given ONLY by the route of administration that the vaccine is labeled for, ie, NEVER inject an intranasal or oral Bb vaccine (can result in death) or give the injectable Bb in the nose or mouth (will not give protection).
a) Injectable ("parenteral") - The only injectable Bb vaccine is a killed ("inactivated") vaccine. Immunologically, the initial vaccination (i.e. first time the dog has been vaccinated for Bb, regardless of age) requires a SERIES of TWO initial doses, given 2-4 weeks apart ... plus a week to respond, before there is immunity. A dead (killed/inactivated) bacterial vaccine is not very immunogenic and is generally not recommended EXCEPT for dogs that are very aggressive when giving the intranasal (or oral) vaccine. Giving a shot is preferred to having a vet lose a hand trying to put vaccine in the nose.
b) Intranasal (IN) - This is a modified live ("avirulant") vaccine that is preferred by most of the experts. It can be given at a younger age (as early as 3-4 weeks) and requires only a single initial dose which can give immunity as quickly as 72 hours. IN vaccines give a better local (in the nose) immune response which is beneficial for an upper-respiratory infection. Also, most IN Bb vaccines come in combination with at least Parainfluenza vaccine ... which is another cause of "kennel cough". Giving both Bb and Parainfluenza as an IN vaccine is felt by most to be the best way to give protection to at-risk dogs.
c) Oral - The oral Bb vaccine came out after the 2011 Guidelines were published. It is also an avirulant live vaccine and shares characteristics with the IN vaccine (but is different, and formulated to work through absorption by the mucous membranes in the mouth/cheek). Last I heard, the duration of immunity was not known, but annual boosters are recommended.
Remember also ... there is no single thing that is "Kennel Cough". The experts now prefer the term "CIRD" (Canine Infectious Respiratory Disease) which can be caused by a variety of viruses and bacteria ... most of which do not have a preventative vaccine available.
Bb is non-core and vaccination is recommended only when there is a high risk of exposure. Even then, generally boosters are recommended annually, unless, perhaps, a dog is entering a shelter or kennel with an active Bb outbreak, then more frequent boosters may be recommended.
The key to FIC seems to be STRESS. Dr Buffington and Dr Chew (and others) have shown a direct connection, though the exact mechanism is still unknown. Dr Chew likes to emphasize that they believe that FIC is more of a neurological disease (how the brain responds to stress) than simply a bladder problem. For that reason, Dr Buffington coined the term "Pandora Syndrome". It is felt that it may be a factor in other chronic problems common in cats, but for most, the bladder effect is the first noticed ... i.e. when cats pee outside the litterbox or make multiple trips and have bloody urine.
What is known is that cats prone to FIC have a physically different reaction to stress. In normal cats, stress begins a series of hormonal responses that activates the "sympathetic nervous system" (SNS) ... which is what causes the "fight or flight" response. For normal cats, once this is activated, it is also quickly turned off. That results in the sudden burst of energy that we all experience when scared or startled and then a return to normal.
But for FIC cats ... there is a problem and the SNS does not get shut off properly. The SNS releases a hormone called norepiniphrine. In FIC cats, there is a continued presence of norepinephrine throughout the body. It has an effect on the cells that line the inside of the bladder and normally cause a mucosal layer that protects the bladder wall from the noxious urine. The norepinephrine causes changes to those protective cells and they become more porous and allow urine to contact the inner bladder wall ... resulting in inflammation, and also increasing and activating nerves and pain receptors ... hence the pain of cystitis.
While the exact mechanism is unknown, it is interesting that research has shown that cats that are prone to FIC have smaller than normal adrenal glands. While the glands are structurally okay, it seems to cause some adrenal insufficiency that may be a factor in FIC. Dr Buffington has a theory (not yet proven) that pregnant cats that become stressed at the point when the adrenal gland is forming in the fetuses, may be the cause of the smaller adrenal glands and the kitten's tendency towards FIC.
What Dr Buffington and Dr Chew have discovered is that by controlling the stress, the frequency of FIC episodes diminishes or disappears. The trick is identifying the source of stress and correcting it. That is what they try to do with the IndoorPetInitiative website.
One area of stress that is sometimes overlooked is the stress of the OWNER. Cats easily pick up on stress of their humans and become stressed. It has been observed at vet schools that just before exams, there is an influx of cats with FIC that belong to the vet students. Dr Chew comments that for every holiday for which Hallmark has a card, there are increased cases of FIC (because of stressed out humans). Moral ... take care of yourself, too!
Most episodes of FIC will resolve on their own in 5-7 days without any other treatment (if the stress can be controlled). So, some think that antibiotics help when in reality the FIC would have resolved without them. Most would recommend giving a cat with active FIC some pain medication (buprenorphine, brand name: Buprenex is commonly used).
Increasing the water intake is always beneficial in order to keep the bladder flushed out and dilute the urine to make it less noxious. It also reduces the chance of plugs or stones forming because the urine doesn't sit in the bladder so long. Thus, if your cat will eat it, any canned food with added water is better than a dry diet.
Guess that is enough for now. I hope I've helped a little. Sounds like stress is a factor for your cat with the new cat. If that relationship can improve, the FIC may also improve.
What you are describing (multiple trips to the litterbox, peeing blood, etc) sounds like classic FIC (Feline Idiopathic Cystitis) which is now being called by some experts "Pandora Syndrome". FIC is NOT a bacterial infection (hence antibiotics will not treat it). Rather FIC is an INFLAMMATION of the bladder which can be extremely painful to the cat (and human women, many of whom are also prone to idiopathic cystitis).
The end of that article directs one to another important site for you to look at ... but they use an outdated link. What began as the "Indoor Cat Initiative" on the Ohio State Univ vet school website ... was later renamed the "Indoor Pet Initiative" because dog people wanted to be included. But the site is done by Dr Tony Buffington (one of the foremost experts on FIC) at Ohio State and he intended it primarily to deal with cats with FIC and stress issues. Here is the current link: http://indoorpet.osu.edu/
I'm just a pet owner, but my "hobby" has been listening to, and attending when possible, talks given at veterinary continuing education conferences by some of the top veterinary experts and researchers. Over the past few months, I've gotten to know Dr Dennis Chew, one of the top veterinary urologists/nephrologists in N America who is now emeritus at Ohio State but is nearly full-time on the vet CE circuit, lecturing to vets. Just over a month ago, I was given permission to attend the NC Veterinary Conference in Raleigh ... and attended 8 talks by Dr Chew (including 2 on FIC/Pandora Syndrome). He is becoming a friend. Dr Chew has worked with Dr Tony Buffington, and FIC has been one of his areas of interest and research.
Last summer I wrote an article on FIC for a Persian magazine based on one of Dr Chew's talks and he reviewed it for me (which led to him inviting me to attend his talks in Raleigh). I can send you a copy if you give me your email address (you can send it to me at: motherstephania at gmail dot com).
Okay, a little info on it here.
If this is an ongoing problem, your vet will want to first rule out other causes. True bacterial urinary infections (UTIs) are VERY UNcommon (1-3%) in cats that are under 10 yrs old. True UTIs tend to be more common in older cats that have more dilute urine (often as a result of kidney disease, diabetes, hyperthyroidism, etc). But to rule out the possibility, a urine sample has to be taken by cystocentesis (needle directly into the bladder) so that the urine is not contaminated by bacteria on the way out or on the fur with a voided sample. You're right, it generally takes a few days to see if anything grows on a culture. You also would need to stop antibiotics for a few days/week before getting a urine sample to test for bacteria.
Your vet will also want to rule out something like bladder stones. Most (but not all types) can be seen on an x-ray. If stones or other things (tumor, blood clot) are suspected, or to rule out other types of stones, then an ultrasound might be done. On the other hand ... urinary CRYSTALS are nearly a non-issue, even if they were present. Dr Chew states strongly that they are not a factor in causing FIC. The only time they become important is for males who may be prone to forming a urinary "plug" that would block the urethra so they can't pee ... which can become fatal in males. Blockages are extremely rare in females because they have a wider urethra ... so, is not likely an issue for you. Dr Chew encourages vets to forget about crystals.
I'm running out of my allotted reply space ... so, I'll continue this in another reply. Sorry I am so wordy, but I suspect that you want this info.
For the core vaccine, DA2PP (Distemper, Adenovirus-2, Parvovirus and Parainfluenza) ... the booster recommendations on the manufacturer's label reflects the testing interval used when they licensed the vaccine with the USDA CVB (Center for Veterinary Biologics). It is ONLY a recommendation and not a requirement.
One of the co-authors of the AAHA Canine Vaccination Guidelines, Dr Richard Ford (infectious disease and vaccinology expert, emeritus now at NC State vet school) is a mentor and friend of mine. I've heard many talks by him and others given at veterinary continuing education conferences. So, I can try to relay some of the info I have learned.
All of the DA2PP vaccines are modified live virus vaccines and give good protection. After the initial puppy series (that should be given until the puppy is at least 16-18 weeks of age) ... then the first booster should be given one year later (i.e. when the dog is about 1 yr and 4 months old). Even if the initial vaccination is given to an adult dog, they usually recommend the first booster be given after one year.
Thereafter, the 2011 AAHA Guidelines recommend boosters for DA2PP "no more often" than every 3 years. In reality, most dogs are probably protected for life for DA2P (distemper, adenovirus-2 and parvovirus). But there are some dogs that do not respond as well to vaccines, so they still generally recommend boosters every 3 yrs or so. Any modified live DA2P vaccine can be used ... whether labeled for 1 or more years.
Booster decisions should be made based on the individual dog's lifestyle and risk of exposure. If the dog is frequently exposed to other dogs with unknown vaccination status, etc (e.g. dog parks, shows, etc) then you and your vet may decide to vaccinate every 3 years or more frequently. Most pet dogs probably don't need boosters for DA2P more often than every 5-7 years (if ever), if they have a low risk lifestyle.
Be aware, though, that some individual dogs can be "non-responders" ... i.e. do not respond to vaccines, no matter how many they receive. And no vaccine will protect 100% of dogs, 100% of the time. So, giving periodic boosters is certainly fine to do. If your dog has a fairly low risk of exposure and is otherwise healthy, then he shouldn't need annual boosters for DA2P.
You can always do a titer test a couple weeks after vaccination to see if there is a response to the vaccine. If so, the dog is probably protected for many years for those core diseases. On the other hand, older dogs with previous vaccinations may not have a titer, yet still be protected ... because vaccines "teach" memory cells that will respond quickly to produce more antibodies if it sees the disease in the future.
For the DA2PP vaccine ... veterinarians do not have to follow the "1-yr" booster recommendation.
HOWEVER ... for the RABIES vaccines ... veterinarians, legally, MUST follow the booster interval for the vaccine given ... i.e. labeled for 1-yr or 3-yrs.
Also, for the non-core vaccines (only given if there is a significant risk of exposure) ... nearly all require ANNUAL boosters. That's because the vaccines are either "killed" (inactivated) which do not give good protection ... or, they are vaccines for bacterial agents which don't work as well as the viral vaccines. So, non-core vaccines such as lyme disease, leptospirosa and canine influenza ... all require annual boosters ... IF they are given at all.
I don't know that the annual vaccinations are responsible for your dog's skin issues, that may just be coincidental. But the experts do try to limit the vaccines for small breed dogs (adult weight of 20lbs or less) ... particularly multiple vaccines given at the same time.
If your dog has had the DA2PP vaccine annually for 3 years, and doesn't have an abnormal risk of exposure, he probably doesn't need a booster for at least 3 years (or more).
I was thinking the same thing lately. I know how busy vets, and particularly specialists, can be. I'm friends with one of the top veterinary specialists (not one on this board) who, even as an emeritus professor, has a work schedule that would kill most mortals.
But it was my understanding that, when creating this "Pet Health Community", WebMD made an agreement with the AVMA. I assumed that meant that the AVMA would arrange for various veterinarians, both primary care and specialists, to monitor and respond to this board regularly. Initially, the AVMA seemed to have a number of veterinarians participating so that no one vet would be overly burdened with replies. There were some specialists that would respond to specific-type questions (e.g. feline, oncology).
I guess, I assumed that if the veterinarians that had agreed to respond to questions got too busy to do so, that WebMD would let the AVMA know and then the AVMA would take responsibility to find other veterinarians to serve the board.
Perhaps my assumptions were wrong. It is true that this board should never substitute for one's own veterinarian ... especially if there is a serious problem that needs immediate care. Even if the vets here were active, they have not physically seen any of the pets here ... and do not have a "veterinarian-client-patient" relationship. So, they cannot "legally" diagnose or treat animals here. They can only give general veterinary information that might relate, based on the information that people post.
But what made this board/community helpful ... and of interest to me, as one who likes to continue to learn from veterinarians ... was the active participation of veterinary professionals. It is disappointing that most/all seem to have disappeared and the AVMA/WebMD doesn't seem to have found others to replace them.
Sorry to hear about your cat. It's always doubly hard when they are so young. Perhaps one more reason to encourage spay/neuter of all cats at a young age. Removal of the uterus and ovaries greatly reduces the possibility of this type of cancer.
The vomiting and not eating for 5 days is also an immediate concern. Cats don't handle fasting well and when not eating for a couple days are prone to developing a life-threatening liver disease (hepatic lipidosis, aka: fatty liver disease). Controlling the vomiting and getting food (and water) into her is a primary concern now.
Was she tested for FeLV (feline leukemia)? I assume so, since it can be a cause of lymphoma/cancer ... so, nearly all vets test for it routinely.
Who did the ultrasound? While some general practitioner vets are skilled with ultrasounds ... most are not, since it takes a lot of training and practice to do and interpret ultrasounds. If you haven't already, you may want to have a second opinion done (if you can afford it) by a veterinary board certified specialist ... e.g. an internal medicine specialist or oncologist or radiologist. Your vet should be able to give you a referral.
I know very little about oncology, so can't help much. It seems that if it is a tumor in the uterus, that an ovario-hysterectomy (removal of the ovaries and uterus ... i.e. a typical spay) would be helpful ... if it hasn't metastasized elsewhere.
Was a biopsy done to determine if it is cancer? Were local lymph nodes aspirated (using a needle to extract some cells that can be examined under a microscope) to see if cancer has spread to lymph nodes ... which causes a more negative prognosis. If your vet feels that this is cancer, if your finances allow it, the ideal is to get a second opinion from a board certified veterinary oncologist.
For some types of cancer, cats can respond well to chemotherapy (which generally doesn't cause the strong side effects that humans often have). Also, it is amazing what can be done with radiation therapy now. I recently wrote an article for the NC State vet school magazine on radiation oncology and their new linear accelerator. It's really impressive!
Also, is your vet a member if VIN (Veterinary Information Network)? It is a website/community, only for veterinarians, where they can go to get second opinions from some of the top veterinary specialists. Vets can upload x-rays and ultrasound images and ask help in interpreting them from the specialists on VIN. And VIN allows for consultations and opinions with multiple specialists ... so that your vet can get opinions from oncologists, internal medicine specialists and radiologists, etc ... all working together to give an opinion.
As for posting photos here. First you have to put the picture someplace on the internet ... e.g. in an online photo album or on a personal website. Then you have to get the url (web address) of the specific photo. Some photo sharing sites will tell you what that url is. For others, you can just right-click on the photo and there is usually an item in the pop-up menu giving the url for the photo (i.e. something that starts with "http://). THEN come back here and start a post (or reply to this one) and just above the composition window, click on the little camera icon (last of the composing options at the top of the box you write in). You will get a pop-up box to insert the url of the photo you want to post. Sounds a bit complicated but isn't too bad once you've done it a few times.
There is an oncologist that occasionally responds to posts here ... but in general, there hasn't been much veterinary input here recently. Your best bet is to look for a local specialist who can examine your cat ... and/or have your vet consult VIN.
I'll start with the bottom line: There are no adverse effects to not giving the second dose of Lepto ... other than that the dog will not be protected at all from the initial dose, so will be at risk of infection if he/she is exposed to leptospirosa.
Lepto is transmitted via the urine of infected animals ... which may include wild animals (raccoon, mouse, rat, skunk, opossum, etc). Most often, infection is a result of a dog having contact with a water source (puddle, lake, etc) that an infected animal has urinated in. Or, if an infected animal pees on the ground, lepto can survive several months ... and a dog that then digs around in the ground may ingest some contaminated dirt and become infected. They can also become infected by eating infected animals.
The other factor is that it is a zoonotic disease ... i.e. humans can become infected as well. Potentially, people can get it from their dog's urine, though it is thought that more often, humans get it from the same sources as dogs, i.e. puddles, lakes, contaminated dirt, etc.
I don't know how prevalent lepto is in FL, but given the type of wildlife and many areas of standing water, it is likely to be an area of risk. That may be the reason for your vet's recommendation.
The other factor is your dog's personal lifestyle ... e.g. if he/she spends a lot of time outside in areas where there might be infected wildlife, or likes to play in water, or may catch and eat small wildlife (mice, rats, etc).
The 2013 AAHA Canine Vaccination Guidelines lists lepto as a "non-core" vaccine ... i.e. only to be given when there is a significant risk of exposure. You have to decide how high the risk is for your dog (as well as yourself since humans can be infected).
Also, when deciding about the vaccine, one needs to know that there are many strains (called serovars) of lepto. There is an old lepto vaccine that covers two lepto serovars (L canicola & L icterohemorrhagiae). It is NOT recommended. If giving a lepto vaccine, one should use one that covers FOUR serovars: the two above plus L grippotyphosa & L pomona. There is not much cross protection among serovars, so vaccinating for four is preferred.
The problem is that there are many more (hundreds) serovars that are not covered in the lepto vaccines. Among those affecting dogs are: L bratislava, L autumnalis, etc. So, the vaccine does not cover all strains/serovars of lepto ... and may have variable effectiveness for the 4 that are covered.
Because lepto may cause significant disease in dogs and people, it is wise to vaccinate when there is a high risk of exposure, but realize that the vaccine cannot give full protection over all serovars. It also only protects for one year, so after the initial 2-dose series, boosters need to be given yearly.
If there is significant lepto in the wildlife in your area, there is nothing wrong with your vet recommending the vaccine. Also, if you have a small breed dog (adult weight 20 lbs or less), it is strongly recommended that one gives only the core vaccines (distemper, adenovirus, parvo, rabies) and then give the lepto (and/or lyme or other non-core vaccines) ... with a minimum interval of 2-3 weeks between vaccinations. Giving multiple vaccines at the same time increases the risk of vaccine reactions, particularly in small breed dogs.
I'm not a vet, but one of the co-authors of the 2013 vaccination guidelines (Dr Richard Ford) is my friend and mentor, and I've listened to many talks given by him and other experts at veterinary continuing education conferences. I have tried to learn and share accurate info, but it is only intended to help you discuss these things with your veterinarian.
Hope things are better now. Thanks for the added info, though I still have questions.
You just say that the vet did a urinalysis and diagnosed a urinary tract infection (UTI) ... BUT my question was HOW was it diagnosed ... e.g. HOW was the urine sample taken? ... and HOW was the infection diagnosed?
If the urine sample was NOT taken by cystocentesis (needle directly into the bladder), then the sample used to test may have been contaminated with bacteria that is not actually in the bladder. So there may not be any actual infection.
If the diagnosis was made very quickly, then the vet didn't have the time to do a "culture and sensitivity" test which requires sending it to a lab to watch for bacterial growth (which takes several days) and then, if bacteria is found, the lab checks to see exactly what antibiotic(s) work best against it. You still haven't mentioned if that was done.
My "hobby" is listening to talks given at veterinary continuing education conferences by some of the top veterinary specialists and researchers in N America. I've heard several say that when examining a urine sample under a microscope ... it can LOOK like a lot of bacteria when it really isn't. There are a lot of other things in urine that can "look" like bacteria and lead to an incorrect diagnosis of bacterial infection.
Since a true bacterial urinary tract infection is quite uncommon in young cats ... it is just a question I have. But, your vet may have done all the proper techniques and testing ... I'm just asking the question.
I've also heard some experts say that while x-rays will see most types of stones ... there ARE types of bladder stones that do not show up on x-rays. So, if there is a continuing problem, the vet may want to look some more (e.g. ultrasound?).
The giving of Amitriptyline suggests that the vet also thinks that the problem is, or includes, feline idiopathic cystitis (FIC) ... since it is a drug that is used for women with cystitis and helps some cats as well. It is an anti-anxiety medication for humans and is probably helpful for some cats by reducing their stress levels ... which is a trigger for FIC. However, one side effect is sedation ... which it sounds as if Boo may be having.
If you haven't seen it, you may want to look at the page on Amitriptyline on Veterinary Partner. That website is run by the Veterinary Information Network (VIN). VIN is only for vets and allows vets to consult with specialists, etc ... but they created VP for pet owners to get good info. Here is a link: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=586
According to that, Amitriptyline can have many side effects and effect any organ system. The greatest concern is that if a cat has a pre-existing "cardiac rhythm disturbance" (irregular heartbeat) the drug can make it worse (potentially causing the heart to stop). It is also cleared through the liver, so if given long-term they suggest periodic blood tests to check liver and other organ function.
I'm not a vet, so am not qualified to tell you what to do. But I would be tempted to seek another veterinary opinion. If you can afford it, the best is a board certified feline specialist or small animal internal medicine specialist. But any second opinion might be helpful.
I think that constipation is only one potential problem with using Amitriptyline, and I'd want more confirmation that it is really needed and that the benefits outweigh the risks. I'd want to know if Boo's sleeping and slow walking are from its sedative effects ... or something else. I'd also ask about giving a pain medication like Buprenorphine (not a pill, is a little liquid that you put in the mouth to be absorbed by the mucosal surfaces). Also, do what you can to minimize any stress.
Sorry to hear about Boo. First, could you give a little more info.
1. How old is Boo? Urinary Tract INFECTIONS are very uncommon in cats under 10 years old (usually given as 1-5% of cats with urinary problems in that age group). On the other hand, in cats over 10 yrs of age, bacterial infections are much more common.
2. How was Boo diagnosed with a bacterial infection? The only way to definitively diagnosis it is for the vet to get a urine sample via cystocentesis (a needle directly into the bladder to get the urine sample). If urine is collected by "free catch" or expressing it ... the urine can be contaminated by bacteria in the urethra or on the fur, etc.
3. If the sample was taken by cystocentesis ... was it then sent to a lab for a "culture and sensitivity" test? That usually takes several days to give time for bacteria to grow. Then, the "sensitivity" part is where the lab determines what antibiotics will work best against the specific bacteria that was found. If Boo really has a bacterial infection, you want to be sure you are using the best antibiotic to treat it.
4. Were any other tests done? For example, x-rays and/or ultrasound to look for bladder stones or (more rarely) a tumor, etc. And also to check the kidneys and/or ureter (tube from kidneys to bladder) for stones or other changes.
5. What are you feeding Boo? Assuming that Boo is urinating okay and not blocked ... then getting as much water into him as possible is important. The best way is to feed a canned food diet and add as much water to it as possible (so it is soupy). Then other things can be added such as water fountains, dripping faucets, ice cubes, tuna water, broth, etc.
6. Is Boo still constipated? That may be a cause of pain. Have you asked your vet about Lactulose which is a stool softener ... to make passing it easier? Increasing the water intake will also help with constipation. Sometimes giving some added fiber helps (e.g. non-spiced pumpkin, or unflavored Metamucil ... but ask your vet before trying it).
7. Have you been given anything else for pain? I don't think steroids are a primary pain reliever. They can reduce inflammation that may reduce pain. But if Boo's behavioral changes are caused by pain, then a more specific pain medication (analgesic) such as Buprenorphine (brand name: Buprenex) may be more helpful.
If Boo is under 10 years of age ... the most common problem (once stones, etc are ruled out) is Feline Idiopathic Cystitis (FIC). It is an INFLAMMATION (not infection) of the bladder. Antibiotics will not help FIC. Usually, with FIC, the best treatment is pain medication to get past the episode ... then increase water intake ... and REDUCE STRESS to reduce or stop future episodes.
Dr Tony Buffington at the Ohio State Univ vet school is a leading expert on FIC and has researched the connection between it and stress. Interestingly, cats prone to FIC have slightly smaller adrenal glands and have a different response to stress. Normally, stress causes the release of hormones that activates the sympathetic nervous system (the "fight or flight" instinct) and then quickly turns it off again. But FIC cats don't turn off the sympathetic nervous system and it results in the release of a hormone that changes the permeability of the bladder wall, resulting in inflammation (cystitis). Dr Buffington feels that FIC is just one manifestation of a more systemic disease triggered by stress ... and he coined the term "Pandora Syndrome" to describe it.
Dr Buffington has a website called "Indoor Pet Initiative" which gives suggestions of "environmental enrichment" to lower stress for indoor cats. It is a site that all cat owners should be familiar with.
IF Boo has FIC/Pandora Syndrome, reducing stress may help. If giving pills is increasing Boo's stress ... then that may defeat the benefit of the pills. I always put pills in a small amount of cheese (Kraft cheese slices) which helps the taste.
I hope you have taken your cat to the vet now. While it may be a stress caused problem, cats don't do well with little or no food. Anytime a cat stops eating or is not eating enough, it is time for a vet visit, if for no other reason than to rule out some things. Cats still have many wild instincts, one of which is to hide weakness and sickness (from predators) for as long as possible. So, we need to watch for subtle changes, particularly change in diet or behavior or daily routine.
You are right that cats don't handle stress well. But it isn't "just" stress. Some cats have a biological reaction to stress that can lead to physical problems. One of which is Feline Idiopathic Cystitis (FIC - inflammation of bladder; not infection). This link between FIC and stress has been shown in research at The Ohio State University by Dr Tony Buffington and Dr Dennis Chew.
They have found that cats prone to FIC often have smaller than normal adrenal glands. Stress causes a chemical reaction that activates the sympathetic nervous system (which is responsible for the "fight or flight" instinct). That's normal. The process also, normally, quickly shuts itself off. But in FIC cats, the sympathetic nervous system doesn't turn off. It releases a hormone called norepinephrine ... which effects the cells that line the bladder ... allowing urine to get into the bladder wall, causing inflammation and a lot of pain.
Because stress appears to cause a more systemic reaction ... of which the changes to the bladder are most noticeable ... Dr Buffington has coined the term "Pandora Syndrome" to describe it. My point is, stress is not just an emotional problem ... it can also be a physical one. If your cat has cystitis, it can be VERY painful. Her lethargy, hissing, meowing, lack of appetite and urinating outside the litterbox can all be signs of pain. Blood in the urine is not always visible to the naked eye.
I'd encourage a visit to the vet to rule out other possibilities. It may be stressful, but she is already stressed and it may diagnose something else that could be more serious. If it is FIC, then pain medication may help her to get through the current episode (it's not an infection, so antibiotics are not necessary).
At the same time, no matter what the physical problem may be, reducing stress is important ... and that includes your own stress. Cats pick up on the stress of human family members and can cause their own stress. I highly recommend looking at Dr Buffington's website, the Indoor Pet Initiative, for some great suggestions on reducing stress for indoor cats. Sounds like you have a good start. The website has a questionnaire that I recommend ... not just to help Dr Buffington's research, but the questions help suggest things you may want to try.
Sounds like you have a very stressful household for a cat. Ultimately, if your female can't adjust to it, you may need to rehome her in a quieter, more stable environment where she may get more one-on-one human attention.