Urinalysis increased bilirubin / protein

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Talishan
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Post   » Wed Apr 29, 2015 10:56 pm


We've used the Hyland Vitamin C baby tablets your client uses, with good success.

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daveandtiff

Post   » Tue Jul 11, 2017 9:12 am


Well, back to our little boy. For reference, we have had few issues with his health, other than some sludge in urine (and urine test off at that time), an injury somehow to one leg a couple of years ago, which led us to monitor and treat beginning of bumblefoot on other feet as he was placing pressure on other feet to guard the hurt leg, all cleared up within a few weeks. Boar butt, which we have cleaned regularly over the past couple of years. Eyes tearing (doctor felt at the time not concerning). Some ear wax buildup. (If we go in for visit, will have these last two reassessed.) His interest in food/hay has always been good.

Right now I am primarily concerned about his skin and a recent urine test which showed blood in urine.

Skin - I had noticed a bit of flaking on skin of his trunk/back. Occasionally when brushing have found some hair coming loose with or without pieces of skin attached. Have been working on his skin lately and his hair has been intact since, so not sure if the earlier was just loose hair he couldn't reach while grooming. The skin looks clear, other than some tiny dry areas and occasional dandruff, and occasionally some tiny almost scab-like patches in various locations as I'm working through his hair. Skin is intact below when these patches are removed and doesn't appear to have been open prior. He doesn't scratch himself in general, but have noticed now a few times when touching certain areas on his back or lower side that he will contort to try to scratch or bite the area I touched and appear to have almost a temporary seizure. Immediately, I was worried about mites, but don't know how he could have been exposed to mites, unless at vet office, last being a couple of years ago. Had started with monistat incase any chance of fungal infection. If you think there is any chance of mites, would probably rather try ivermectin at home rather than skin scraping (if this is not always conclusive anyway). Or perhaps it is just dry skin. I can try to post photo.

Blood in urine - this was based on one test, so need to try to get another, harder to get clean urine from him. He does squeak at times while trying to remove impacted poop, so cannot be sure if any of this could point to sludge/stones as it's inconsistent. If we are to visit doctor, I think we'll have an ultrasound or xrays. I've checked penis for sludge and a little is occasionally there along with softer white material, but not often do I find sludge spots on his blankets. UTI was another concern. Took his temp and it was 99.5 two days ago. Am thinking there was possibly trace protein in urine (this one I hadn't recorded as was multitasking), so will get another urine.

Eyes - he had what appeared to be ulceration of R eye, had applied Terramycin ointment to it for a week. He was not squinting, but surface of eye was not uniformed. Thought to add it as precaution. He does still have white spot over R pupil now, but surface of eye looks more smooth. Incidentally, he's had a pale white ring around the colour of his L eye for some time. Am wondering if age-related changes or otherwise. Vision doesn't seem to be significantly (or at all) impaired.

Mobility - he has always preferred to stay in his shell (igloo) or within a hay pile, his safe places when he wanted to be away from his brother who was at times bossy. I do worry about how this has affected his joints. He does walk normally and I have right along removed the shell often to encourage him to move around. With his age, am especially focused on him moving around more, for joints, muscles, heart, moving sludge out, intestinal tract, and to keep him from sitting in pee/poop. His blankets get changed several times a day and I occasionally need to clean lower abdomen or backend.

Would you have any thoughts on the skin or urine findings? Thank you!



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Talishan
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Post   » Tue Jul 11, 2017 1:30 pm


Skin: definitely treat at home for mites.

They don't have to 'come' from anywhere -- they are present in very small numbers, and the pig's body keeps them under control, unless they flare up, much like many of the microbes, parasites and fungal stuff that the human body carries around and deals with.

Have you seen any occult blood, or just subclinical on the test strips? I'd consider an x-ray for sludge or developing stones, especially since he's male.

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daveandtiff

Post   » Tue Jul 11, 2017 7:30 pm


Okay, will have to learn on proper dosing for mite treatment for him. I'll try to get a picture of his skin/hair tonight.

I haven't seen occult blood, at least obvious from rectum or in poop, but the urine stains seemed a bit browner, which is why I decided to test urine. I did ask doctor's office today about running a hemoccult and she said she didn't know if this is done, but it could probably be ordered, would be sent out if so. I'll try to get a clean urine from him as well to have a UA run. And think the xray is a good idea since we're seeing this stuff in urine at least. When I took him in for U/S in Apr 2015, he was neg for stones at that time (that was the time I'd found a hardened piece of sludge wrapped halfway around his penis and worried something more could be happening in his bladder). He does have a gritty feel at times to the white material around his penis when I wipe it off. I usually rub it between my fingers to check, so I know he's not out of the woods. But am hopeful he's getting that stuff out regularly with pee. I need to get him moving around more to help with that.

Talishan
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Post   » Wed Jul 12, 2017 2:46 pm


I would want an x-ray. Fwiw.

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daveandtiff

Post   » Wed Jul 12, 2017 9:59 pm


Yes, am planning it. Possibly xray of heart and lungs as well. Had spent the past hour listening to his lungs and heart, counting, checking various body parts. His breathing seems more noticeable than I think it should (in comparison to the others, and just from knowing normal). Breathing was around 100rpm and heart was closer to 260bpm. I don't think URI, but do want to check heart. And he peed on me several times, at first all looked clear as I was wearing white, but once on my hand and could see a reddish tone as it was coming out (confirmed blood). And squeaking while peeing. We're scheduling. He's otherwise getting around quite a bit today to his hay and food, acting hungry and perky.

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daveandtiff

Post   » Sat Jul 15, 2017 9:53 am


Just an update, Talishan was right on with the xray. He has a decent-sized bladder stone, possibly the size of a pea. Doctor could not determine if it is adhering to bladder wall or floating, but prescribed 0.25cc/bid metacam and Lysimachia (instructions are to crush 1/8 tab mixing into fluid and split this dose to twice/day. The tab is ~3/4" long, strength not noted.) While in the office, he peed and she was able to draw up a good-sized sample to send off for UA (blood in urine) to determine if UTI and antibiotic needed. She said standard recommendation is to have surgery to remove, but is willing to wait and see for now. He pees often so will be watching constantly for this and ER visit if any chance of blockage. I think we will have another xray at some point to check status and see if it is not in the same location (try to get a sense if adhered or not). He does squeak/grunt at times when eliminating (poop usually, but now noticing with pee), but is active and walking around, eating and perky. This morning I opened up alot of extra space for him to explore and he was still going while his colleague, Sassy (usually the feisty and more active one) konked out well before him.

Doctor checked the bits of dandruff and felt it would be smart to give a dose of Revolution and see if it helps him. She didn't want to treat the others at this time (she doesn't usually want to if they are not exhibiting symptoms). So will see how he does and would need to go back for an additional dose.

She also stained the eye that I was treating with Terramycin and thought it could be a near-healed ulceration, suggesting I continue the Terramycin for awhile longer (she suggested three times/day).

So the goal is to keep him moving and hydrated, edit his diet additionally, and keep him more comfortable with metacam for now. And also see that his weight can get back to what it was where he is older.

As far as diet, remembering possible link between stones and romaine? He prefers carrot, we'll need to take this out or reduce this? Will be getting a few more water bottles so they are at all sides of his cage.

He's on mix of Oxbow/KMS mostly, with occasional "treat" food added (I don't think he's a huge fan of the KMS, but will probably try to make this more primary if he'll take it). Several types of hays. I remember that the piece of sludge I'd found on him two years ago dissolved in (if remembering correctly) vinegar, so would this suggest the stone is calcium carbonate? Had read Lysamachia can reduce inflammation and works to break down calcium oxalate stones in some animals, but does it affect calcium carbonate stones? If he does have calcium carbonate stone vs calcium oxalate, should we keep giving outdoors greens in moderation (grass, dandelion greens, carrot tops)? Thinking of the calcium:phosphorus ratio as something we should be considering? Reducing calcium is what we should really be considering?

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daveandtiff

Post   » Sat Jul 15, 2017 5:03 pm


He is having more consistent blood in urine and is starting to worry me. At what point would this become a need for surgery? How much do they bleed usually with stones (or UTI if lab shows this?)? Thinking back on our boy whose mammary tumour bled for awhile, I was looking to not see more than 1-2cc's. With this showing in urine, I cannot tell how much he is actually bleeding out, but it shows each time he urinates it seems and at varying degrees of diluted red.

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Lynx
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Post   » Sat Jul 15, 2017 10:03 pm


I can see how this would be worrisome. Sometimes in humans with blood loss iron supplementation helps.

Talishan
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Post   » Sun Jul 16, 2017 1:42 am


Offer him some fresh, cold pulp-free orange juice. Many pigs love it, and it really helps recovery from blood loss.

Carrots are fine. We've had multiple issues at our house with romaine; we now use it only as a mix-in and only for those pigs with no calcium, blood, or pee-related issues.

Dandelion greens are *very* high in calcium iirc. Does he like bell pepper?

Does his pee smell at all? Infection usually smells different from hematuria, even if neither smell exactly great.

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daveandtiff

Post   » Sun Jul 16, 2017 3:39 am


Lynx, I had a whole note back to you, fell asleep with finger on keyboard and all locked, lost info as didn't copy when I tried. Will rewrite when a moment, in between feedings/clients. Still blood in urine throughout, need to pick him up and give fluids, have added some orange, Talishan.

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daveandtiff

Post   » Sun Jul 16, 2017 5:17 am


Just [set] put him down. Trying to get him used to syringe feeding incase we're needing surgery. Trying many ways of positioning syringe to mouth, holding him up, thumb on nose, all the tricks...he on the most part responds with wide open mouth pushing tongue against syringe to try to get it out and will get about 0.2cc down the chute at a time at most with alot of it dribbling out. It's imperative that he learns how to eat this way, it would be hard enough to get him to want anything after this surgery, let alone if he's already not adjusted to being able to eat from syringe. We have work here.

Lynx, you were thinking the same way I've been, on keeping iron at a normal level/preventing anemia. There are certain foods that contain iron that are considered "iron absorption inhibitors" (like spinach, chard, kale, I believe) and these foods are usually needing to be paired with "iron absorption enhancers" (citrus, strawberry, cantaloupe, Vit C) to make them most beneficial. Other foods (non-heme) that contain iron that we could consider - beans, peas (but we usually only give these as treat to boys due to potential for gas. don't give to girl because of her ovarian cysts.). Pepitas (pumpkin seeds) are higher in iron, too. And dried fruits (like raisins, though we keep away from these since conversation here awhile ago with bpatters on possible issues with grapes/raisins for pigs as they are problematic for other animals). There's iron in Critical Care (but not seeing it in KMS or Oxbow pellets?). There's also iron in molasses (but not ideal with sugar) and quite alot of iron in Cream of Wheat, but not sure if that should be given.

The other thought was getting bleed to clot. When Wickie had bleeding mammary tumour, I'd tried a dusting of vegan Vit K supplement. I noticed that Lysimachia is considered anti-inflam and has a higher tannin content, so while it might not break down the type of stone he has, it might help with inflammation and hopefully constrict vessels a bit to control bleed more. He's had 2nd dose of Lysimachia so will see if helps as we move through the day.

I added orange to his syringe mix, Talishan. It's a bit more runny so he'll get more fluids. He doesn't seem to want to drink juice straight (he's always loved Critical Care. Only, it's been given to him on a spoon throughout his life, so that's what he's used to). Wanting to increase fluids, what he can do on his own, and some extra by syringe...to increase fluid volume in bloodstream, and to get him used to taking syringe.

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