Urinalysis increased bilirubin / protein

Talishan
You can quote me

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
RESIST

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
You can quote me

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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Lynx
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Post   » Sun Jul 16, 2017 11:47 am


I edited your first line. I thought you wrote you had him euthanized at first so made it clear that was not what you meant.

Sending good wishes!

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daveandtiff

Post   » Sun Jul 16, 2017 11:55 am


Oh gosh no! Thank you, Lynx!

And was remembering Talishan's question. At times the pee has smelled off, but I sniffed this morning and wasn't detecting smell. It was hard to determine earlier when smelling if it was a blood smell or infection (probably smelling poop as well). Am picking him up now to try to hydrate and get him better used to syringe so will check again.

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daveandtiff

Post   » Sun Jul 16, 2017 12:48 pm


He is squeaking with every urine/poop, while on metacam (7 hrs out), diluted blood, a little less than yesterday. Doesn't have odor beyond urine ammonia smell, at least this last round. He's struggling with syringe, but more relaxed (through body language) with the process, just dribbles out anything past 0.2cc's and at this time has to have head raised to get it (gravity), which I'd rather avoid if we can learn a more level way of accepting, especially if out of it after surgery (aspiration risk). Slow process, but other than trying to lift his head away or push syringe out with his tongue, he's not trying to walk away (and he seems to be content with flavour, it's a bit more juice than CC, usually is the other way around on his spoon treat).

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daveandtiff

Post   » Sun Jul 16, 2017 11:33 pm


A little happiness for the moment...he found a juice he loves and he seeks this out (took about 18cc's straight through, not counting the dribble). But food is another story. He's been a bit of a food snob (when introduced via syringe). It has to get into mouth just so, stay there as he is trying to push it out, and with a small droplet as introduction he realizes this could be okay, and if acceptable he will start to latch on as though a water bottle nozzle. He's not a fan of it initially entering his mouth, though, so considering 3cc syringe if can find one with a bit longer tip so can keep in mouth a bit longer until he is ready to pull away. By no means does he want to eat the food for very long, but the juice he has really taken to. Probably good, he needs to replenish fluids.

Juice of the Day: 1 baby carrot, 2 larger blueberries, 2 slices bell pepper, 1 slice cucumber, 1 slice cantaloupe, 1 larger slice orange, 3/4 leaf green leaf, small slice tomato. Little girl is a little less excited by it, but acceptable when mixed into her food. Will probably be on double juice duty from now on, making a couple of blends at a time.

He's still showing blood in urine. It seems a bit less than yesterday, but still steadily happening. Am just hoping he's restoring cells quickly enough to keep up with losing them. Should he be encouraged to run around or kept more still with this bleeding? Wondering if activity will aggravate the area and create more bleed. It seems he bled more during and later after his morning play session yesterday, so thought to ask.

Wheatgrass - this is lower in calcium and okay to serve, correct? Was seeing it may contain as much phosphorus as calcium, both very low, according to nutrition data online, but want to double check this info. What about grass from outdoors? Am not sure what names of the different outdoors grasses are, have been wanting to identify them to be able to learn what each contains...is there any spot online that helps with grass identification?

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Lynx
RESIST

Post   » Mon Jul 17, 2017 9:54 am


I don't have good figures on wheat grass but if that's what you found and it was a reliable source, sounds good.

Most grasses are fairly similar in nutritional value (from what I understand). They are influenced by how they are grown, too.

p.s. pretty tasty sounding Juice of the Day!

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daveandtiff

Post   » Mon Jul 17, 2017 8:34 pm


Okay, thank you, Lynx. We'll probably continue with the wheatgrass then since it's got some good nutritional value, and the outdoors grass in moderation since it's the one grass they all really enjoy.

Nutter is willing to offer you a few cc's of his juice :D Had talked with doctor a couple of hours ago, and she feels it's always good to hydrate, but to be sure it doesn't interrupt his food intake. He will go for syringe food IF he loves it, but sometimes the way I can get food in is by drawing it up first and then some juice at the tip. At least he is getting the hang of the syringe, which was one of the main reasons for giving him feedings this way. He's also lost 20g since last weigh. I think alot has to do with him not getting around as much, so have been putting food/pellets/hay close to him throughout day to encourage him to eat more. Usually he's good with eating, but the discomfort is probably impeding.

The doctor said UA came back with some crystals, RBC's, but no WBC's or bacteria. It was very dilute, which she said is fairly common. And I believe she was able to determine what was seen was calcium carbonate, though she said there can be other material as well. We're foregoing Bactrim at this time based on results, and will watch, sniff and let her know if anything changes. She said it is rare to see enough blood lost via urine to lead to anemia (that was one of my main concerns where he is showing blood in urine with each time he urinates, at varying degrees).

When I asked about the size of stone (was remembering her showing me with her fingers what size it looked like on the xray), she said she felt it was smaller than a pea. She didn't measure. She said we would get better information on if the stone is adhered by an ultrasound (they may be able to move it around if not adhered).

So keeping up with metacam, white blankets and regular feedings and hoping for the bleeding to settle down.

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daveandtiff

Post   » Tue Jul 18, 2017 2:41 am


I think we may be in a bad situation. He's dropped another 20g in one day, now down to 975g. Last Friday he was 1019g. Am working on syringe feeding, but he prefers the juice to a certain point and doesn't want to take more than a few food cc's, so rest is somewhat forced, and is not more than 12cc's or so in a session. Last session he timed out after about 7cc's juice and accepted only about 3cc's of food willingly because there was some juice on the tip. I can't imagine what he would be able to do after a surgery. Thought he was really moving along with the process, but he's back to rejecting.

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Lynx
RESIST

Post   » Tue Jul 18, 2017 9:00 am


I know you are on top of this and you will do all you can to help him improve.

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daveandtiff

Post   » Tue Jul 18, 2017 5:22 pm


Finally he took the food willingly, about 10cc's, but am thinking it was because the juice in mix was just freshly made. Also, he had metacam dose 4hrs ago, which may have helped. Am going to see if keeping juice in freezer and thawing each session (vs keeping in fridge) will keep the flavour better longer. I used to have to juice each session with two of our others due to pickiness, but cleaning the juicer components takes awhile. Have a back-up juicer, may need to figure out how it works so can have two in rotation. Haven't yet weighed him. A little nervous about it, will plan to after the night is over with clients. Crossing fingers...

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daveandtiff

Post   » Thu Jul 20, 2017 3:38 am


Just a quick update. He had a little burst of energy earlier, going for pellets, some vegetation and even water bottle once (don't think he has past few days). Not sure what brought the energy, was 9hrs post-metacam, 5hrs post lysimachia. During an earlier feeding he really pushed hard with a big grunt and squeak, obviously painful, more than the usual. But then was not hearing squeak with pee much or at all later, until later evening. I doubt he would have passed stone, but will check blanket when home shortly for next feeding.

He was 984g night before and 1004g tonight so improvement. Found freezing juice and thawing freshly did make a difference. He's only taking food willingly if juice on tip, and requires a good 5 mins to consider starting.

Had read male urethra is about 1mm at pelvic end and about 3mm at spongy area, so if stone were smaller than a pea (will need to ask if can be measured) probably not likely it would pass through, correct? Would it be problematic to use shilintong? Would it relax the urethra enough that stone could go in and jam? I guess I'd really need measurement to consider this more. Also, if there were a blockage, how much time would we have to seek help? Had read catheterization can be complicated due to anatomy so would really want an experienced pig person.

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daveandtiff

Post   » Thu Jul 20, 2017 4:10 am


Correction: he was 1007g (small difference, but in the positive, worth correcting :)) and unfortunately no stone on blanket.

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Lynx
RESIST

Post   » Thu Jul 20, 2017 8:29 am


I do not remember warnings against using shilintong for males. Might be worth a shot!

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