*URGENT* Passing blood...squeaking

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Becky

Post   » Sun Dec 23, 2007 10:05 am


I wouldn't bother with the polycitra. It is not a quick fix by any means. All I can say about the ureter stones is from my own experience.

With Cookie, she had several stones in her bladder. She then started developing them in her kidneys which led to eventually blocking her ureters. Under those circumstances, we opted for no more surgries and just supportive care.

With Elvis, he had one stone in one ureter. No sludge or stones anywhere else. We knew the cause of that stone was supplementing with calcium, so our plan was to remove the kidney. We had no reason to think that he would form another stone if we adjusted his calcium supplement.

Personally, I wouldn't consider the surgery. I'd continue the subcues for sure but yes, you can tax the kidneys. I'd do it every other day until you can talk to your vet, but I don't think it would hurt if you did do 15cc's once a day for a week.

You won't find anything to dissolve the stones, I'm afraid. Also, the muscle relaxant (shilongten?-sp?) might help the bladder stone, but I have no idea if it would have any impact on the ureter stones.

I really don't want to discourage you, but the fact that there are multiple stones in one ureter and another in the second ureter really is not encouraging. I think it's Josephine who always says, "Hope for the best; expect the worst."

You might email her to see what she has to say.

User avatar
sef1268

Post   » Sun Dec 23, 2007 11:53 am


I emailed her last night.

I know that the stones themsevles can't be dissolved, but I'm just wondering if the cyrstals can be dissolved before they turn into stones. Vet said there was quite a few oxalate and I think magnesium(?) crystals in his urine.

I'm looking for some way to prevent the other ureter from getting blocked. Is there anything at all we can try?

None of this makes any sense. He was a seemingly normal pig a month ago...popcorning, playing. Now he has numerous stones, despite what I thought was the right diet.


This really is the pits.

User avatar
somechick

Post   » Sun Dec 23, 2007 11:59 am


I'm so sorry about all this sef. I feel so ill for you.

It seems like getting the stones out of the ureter isn't an option due to cost and complexity. So could you remove the whole thing? Kidney, ureter an all? (I know you don't want any surgery.) I'm sorry if I'm totally talking out of my rear, I'm just trying to think of anything.

As far as keeping the other one unblocked - there has to be something out there to prevent that.

I wish I knew anything. I'm sorry I have nothing to offer.

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Maja

Post   » Sun Dec 23, 2007 12:20 pm


sef1268, I'm sorry that you're going through this, I've been following your story.

I don't know if it's going to help any, but with humans, we use Spasmex, analgetics, iv fluids and warmth to help pass the stones when they get stuck.

...when my own pig had stone problems I was giving her more fluids (up to 50 cc a day) divided in 3-4 doses

Josephine
Little Jo Wheek

Post   » Sun Dec 23, 2007 2:07 pm


Unfortunately, uretral stones are a b*tch. You aren't going to get them to dissolve. Usually, removal of the kidney and ureter is the treatment at this point. That is a seriously invasive surgery and I would suggest it has a high incidence of complications and mortality in other animals, and I would assume more so in a guinea pig.

What kind of crystals are there? That will tell you if you need a urinary acidifier or not.

I would attack pain on two fronts for complete pain management. That means an NSAID (like meloxicam) with a narcotic or opiod (buprenorphine, tramadol, etc.). All those can easily be given orally or transbuccally in the case of the buprenorphine.

If you can manage the pain, he can do fine on one kidney for some time. It's the stones and crystals (and associated chronic infections) that cause diminished quality of life at some point. You need to gauge how that goes with your vet.

I would suggest that the 15 ccs of fluids are fine if he is drinking normally. If not, I would definitely suggest (if his heart is fine) that upping the amount may be helpful. I would definitely consult with your vet since I do not know why the overperfusion of the kidneys was a concern. She knows more of the story than we do here.

Talishan
You can quote me

Post   » Sun Dec 23, 2007 5:27 pm


I have nothing useful at all to add except my best wishes to Zach and to you.

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sef1268

Post   » Sun Dec 23, 2007 6:56 pm


Josephine, the vet said there were oxalates in his urine and (I think) magnesium-?

Josephine, when you say he can manage with one kidney, does this mean if the other one fails he could, in theory, continue to manage with the other one. OR, do you mean if we remove the one kidney and ureter? What happens if we leave them in?

Is there any supplement, herb, medication, anything, that we can try to help reduce crystals or prevent them from forming more stones?

He is drinking on his own. You say that 15cc's might be enough if he is drinking...do you think daily is okay? What do you consider to be "too much" fluids?

Also, with the pain management. Zachary has such a sensitive gut. Is Tramadol or other opiates relatively well tolerated?

All of this is just making me feel so sick.

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sef1268

Post   » Sun Dec 23, 2007 9:11 pm


On a positive note, Zachary has been even perkier this evening. I think the antibiotics were making him feel even worse. He has been trotting around, nibbling hay, drinking water, and even eating a few pellets (I'm not offering many). In between those pain spasms, he seems more like his old self.

The bad thing, is that his poops are now small and extremely soft. I don't know if it's from the AB's or too many wet veggies (in an effort to hydrate) or both. I gave him another small dose of Bio-Sponge this evening -- .3cc's. Looks like I'll need to cut back veggies a little, at least until his gut gets back to normal.

What can he eat, then, if he probably shouldn't have too many pellets and can't eat too many veggies?

Tracis
Let Sleeping Pigs Lie

Post   » Mon Dec 24, 2007 12:45 am


So glad that Zachary is feeling a little better.

"What can he eat, then, if he probably shouldn't have too many pellets and can't eat too many veggies?"

Does he still enjoy eating hay? That is the main staple of my Ginny's diet, since she has many food restrictions.

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sef1268

Post   » Mon Dec 24, 2007 9:46 am


Thanks, tracis. I knew I was pushing my luck with the subcues, though...this morning's was a disaster (and it seems like once you screw it up, they are "on to you" and it becomes a lot harder from then on).

Yes, Zach still enjoys his hay. I have botanical hay, orchard grass and timothy that I'm mixing to give him some variety.

He does seem a little interested in pellets, but I'm only giving him a very few daily. Not sure I should even do that, but he has dropped quite a bit of weight.

Josephine
Little Jo Wheek

Post   » Mon Dec 24, 2007 11:32 am


Too much? More than 30 ml/kg/day if drinking and 60 ml/kg/day if not. That is given the kidneys and heart are functioning fairly well and fluid overload is not a concern.

I don't know if urinary acidifiers will help. I know vitamin C does acidify the urine somewhat, but probably not to the extent an acidifying drug would do.

His diet definitely needs to be primarily grass hay. If he is eating pellets, it is a concern for his urinary tract health as well as his dental health.

I meant one kidney functioning (whether the other is left or removed). You only need one to live.

Yes, the tramadol and opiates are the easiest to tolerate GI drugs. Metacam is much harsher in comparison. You want to ideally attack the inflammation (cause of pain) as well as give something FOR the pain. The only problem with long-term opiates is that they can slow the GI tract down. If he is having bouts of mushy stool, then that certainly won't be a problem for you!

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sef1268

Post   » Mon Dec 24, 2007 12:54 pm


Thanks. Well, what concerns me about slowing down the gut, is that this was the original complaint last month -- motility issues (lots of gas; straining but not passing poops, and then passing many small ones at one time). Until he recently started hunching and crying when urinating, I had no idea we were dealing with stones. I'm still not sure I understand if he has TWO issues or one. Can stones in the ureter somehow cause motility issues? (maybe from tensing up the muscles when eliminating?)

I assume a kidney function test is going to be important right now, to get a baseline. Given that the vet couldn't get a decent blood sample (despite sedation), is there any other way to gauge it?

Josephine
Little Jo Wheek

Post   » Mon Dec 24, 2007 1:09 pm


"Can stones in the ureter somehow cause motility issues? (maybe from tensing up the muscles when eliminating?)"

Yes.

The only other indication of kidney function is testing the urine to see dilution/concentration, presence of various things (e.g. pH, protein, WBCs, RBCs). It'll give you an idea, but not the same info as blood. Still, better than nothing.

User avatar
sef1268

Post   » Mon Dec 24, 2007 1:28 pm


Thank you so much, Josephine. This is all good info. Can I ask what your own thoughts on Metacam dosage are? I know there has been extensive discussion here on what is considered a "safe" range. Carpenter's own position on it (rodent vs. rabbit dose in guinea pigs) is a little unclear, considering that he took his cue from a colleage in the UK and that colleague didn't do much to clear up the question when Elsevier contacted him directly about it (if I remember correctly, he essentially said it was the correct dose for rats).

Boehringer Ingelheim's statement to me about dosing at roughly a drop per pound makes me unsure about the safety of higher doses.

A former vet of ours did dose at 1-2mg/kg. A second exotics vet that we went to saw this in Zachary's chart and said, "I assume you figured out that she had dosed the Metacam incorrectly."

Just curious what your own experience has been.

ETA: Not sure if this is useful or not, but Zachary's urine pH is 9.0.

User avatar
Lynx
RESIST

Post   » Mon Dec 24, 2007 4:17 pm


Was she instead suggesting tramadol and opiates rather than meloxicam?

Josephine
Little Jo Wheek

Post   » Mon Dec 24, 2007 4:39 pm


The vet?

You need to use both for appropriate pain management if there is pain. The opiates can be an on again/off again thing if the pain is usually managable. The NSAIDs are usually long term.

I do think a lot of things are underdosed in cavies due to their metabolisms, BUT that said, I think NSAIDs are harder on herbivores than omnivores and can really tax the liver and kidneys. So, I tend to go on the lower side for meloxicam (0.2 mg/kg). 1 mg/kg sounds high to me in any animal--especially long-term. You can get away with a higher dose for a few days, but it will catch up to you if you're using it longer than that.

I think the urine pH should be around 8.0, so maybe acidifiers would help?

User avatar
sef1268

Post   » Mon Dec 24, 2007 6:26 pm


Lynx -- the former vet was suggesting a dose of 1-2mg/kg for guinea pigs w/ Metacam only.

Josephine -- I am leaning towards the polycitra. And I do have a small amount of Torb here...thinking maybe I'll go ahead and start him on that, plus the Metcam. It's so hard to dose Metacam accurately with a syringe, but I have been getting roughly 2 1/2 drops in him (approx. .05) twice a day. If I base his dose on .2mg/kg, with his weight at 1 kilo, it should be closer to .02, so maybe I should bump that down a little when I start the Torb. My vet hasn't been on call this weekend or today, but I'll go over all of this w/ her when she is back in the office on Wednesday.

Really annoyed with myself for screwing up the subcue this morning...he was doing so well with it.

User avatar
sef1268

Post   » Mon Dec 24, 2007 7:23 pm


Sorry, Josephine -- I mis-read your comment. You said "acidifers," not "polycitra."

Something that confuses me, though, is that oxalate stones supposedly have trouble existing in an alkaline environment (from what I've been reading, they're typical to acidic environments, whereas struvite stones are typical to alkaline environments). Given that guinea pig urine is highly alkaline to begin with, how in the heck do oxalates form??

From marvistavet (emphasis mine):
By taking potassium citrate orally, citrate levels increase in the urine. Calcium binds to citrate instead of to oxalate which is a desirable event since calcium citrate tends to stay dissolved whereas calcium oxalate tends to precipitate out as mineral deposit. Potassium citrate also helps create an alkaline urine (in which calcium oxalate stones have difficulty forming). Potassium citrate supplements are typically given twice a day.

Josephine
Little Jo Wheek

Post   » Mon Dec 24, 2007 7:53 pm


Hmmm... I thought it was the other way around (struvites in acidic and oxalate in alkaline).

My mind is somewhat fuzzy. In any case, I'd run it by your vet.

User avatar
Maja

Post   » Tue Dec 25, 2007 6:49 am


I was giving Mina magnesium citrate and it helped her in reducing the stones, but they were really small to begin with. We haven't had ultrasound done since May, but she's no longer peeing blood (knock on wood), so I guess it must have helped somewhat.

I'm also not sure what was the nature of her stones, my vet thought one thing, but I ran some tests by myself and I believe they were carbonates. I think that I read on here that carbonates are often misdiagnosed as oxalates. Her urine was also alkaline (pH=9) which is normal

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