Urinalysis increased bilirubin / protein

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daveandtiff

Post   » Thu Jul 20, 2017 6:24 pm


I was just wondering if the stone could get stuck in urethra if the stone is too large to pass, where shilintong may relax the urethra.

There has been red blood in urine this past week, but what would make urine brown? This may be what I was seeing earlier, brownish pee (that I was thinking was pee with poop from his boar butt smeared over it at the time, but now am seeing it seems to be the pee that is brown). It's a medium brown as soon as it comes out.

bpatters
And got the T-shirt

Post   » Thu Jul 20, 2017 6:38 pm


Brown is usually oxidized blood, not fresh.

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daveandtiff

Post   » Thu Jul 20, 2017 8:24 pm


bpatters, when blood sits for awhile on blanket I've seen it turn brown as it dries, assuming as air works on it, but I was holding him for feeding and while on a clean spot of blanket he peed. I looked right away and it was brown. This happened a few times so that's what I thought was odd. Can it oxidize while in the body?

bpatters
And got the T-shirt

Post   » Thu Jul 20, 2017 8:52 pm


Yes, if it's not fresh. I don't know how long it takes to do that, however.

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daveandtiff

Post   » Thu Jul 20, 2017 9:02 pm


Okay, was really worried about what it could mean. I know it's not good that there's blood at all in any form. Am just hoping old blood or not seeing red maybe is at least not active bleed.

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Lynx
RESIST

Post   » Thu Jul 20, 2017 9:06 pm


If it has an orangish tinge, it may be porphyrins.

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daveandtiff

Post   » Thu Jul 20, 2017 9:13 pm


There may be porphyrins mixed in, too, but it's definitely brown. Was seeing brown prior to his diagnosis, too, but was thinking it was poop from his boar butt smeared over urine spot where he tends to stay in one spot for a length of time. For a week, he's been showing more red in urine, especially since the weekend, and today more brown.

Talishan
You can quote me

Post   » Fri Jul 21, 2017 12:05 am


Does the more-brown stuff have any different, bad or odd odor to it?

How much time: if he becomes fully obstructed, you will know it. He will be *screaming*. A competent ER vet will be able to draw urine out of the bladder using an ultrasound-guided needle. That will relieve pressure on the bladder while surgical options are considered.

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daveandtiff

Post   » Fri Jul 21, 2017 1:05 am


It still smells like urine with undertone of blood. Keep smelling it to detect any sort of infection smell. I think I'll try urine strip when home shortly between visits to see if it might pick up wbc' s and take his temperature again. He did feel warm, but don't think unusually so. He got a decent amount of syringe food and watered juice and has been scavenging better.

The idea of him blocked makes me nervous about when it could happen, if at a time exotics doctors or surgeons off duty. Am going to keep praying this doesn't happen. He is grunting or squealing briefly when pushing poop, lightly crying when peeing. It's seems like a brief stabbing pain during poop push and then he returns to eating or sometimes just sits. I've put light pressure after with a finger on underside to side of bladder and he stops whimpering (finger between crook of leg to reach without moving him). Not sure if helps truly, but hope. Extracting poops often so he doesn't have to push and he's eating a good portion of them. Would vibrating surface be too much for him, could it bring on more blood? Have hesitated to do this for this reason, though was wondering if vibration could help to dampen or change pain signals and float debris for peeing out if new stuff is forming. Would having him stand during pee help navigate debris out with gravity (we've done this a few times)? Is his metacam dose (0.25ml bid) strong enough based on his behaviour? Not sure if should increase it.

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daveandtiff

Post   » Fri Jul 21, 2017 6:13 am


Was able to get a very good urine sample and blood (red) really showed up in the urine this time. WBC's looked neg on the strip and protein was off (but this could be anyway). Temp was 100.9. Otherwise, he was going after his new vegetation and looking alert.

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Lynx
RESIST

Post   » Fri Jul 21, 2017 11:08 am


I am guessing the vibrating could be a plus. It might help things move out of the urinary tract and be distracting and in a way soothing.

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daveandtiff

Post   » Fri Jul 21, 2017 12:31 pm


Might try it today when he seems to be showing more need. He is definitely getting around for things to eat in between rest/sleep. It doesn't seem to be causing a significant lingering pain, the intensity more at the time of his pee/poop and a little bit following. Had put a call in to doctor to see if the stone image on xray can be measured and mentioned considering shilintong. Will post what I hear after call back.

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daveandtiff

Post   » Mon Jul 24, 2017 9:10 am


We had a weight drop to 960g yesterday, at 970g this morning. Realizing increased syringe feeding needed, though do not want to interrupt his interest in eating on own. Have been placing new items in front of him regularly through day and he continues to go for them with interest, only interrupted when he's having pain pooping/peeing. Alternate hidey spot and remove often to encourage him to explore, which he does. Alot of the time he's just acting like himself and seems bright, though I know the underlying pain probably lingers if he is losing weight. Yesterday seemed to show darker blood in urine, and the blood has not stopped in varying degrees. I just don't know how long we could see this, doesn't seem to be settling, and worry about too much blood loss. Am waiting to learn measurement of stone to try to think on if there is any chance it could pass on its own or not. Have been getting him to play area several times a day to have him run around more and change position off from feet (one back foot a bit red so have had him extend it and have massaged around the area during feedings and have been putting cream on it. Last thing he needs is bumblefoot, too).

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daveandtiff

Post   » Mon Jul 24, 2017 10:28 pm


Am worried about his blood in urine. It's visibly red or diluted red multiple times while I'm holding him during feeding, and while in cage it absorbs into blankets more so apparent, but not as bright. Had left another message with doctor's office today about this and to ask for stone and urethra on xray to be measured (to try to decide if we should consider shilintong). Received a call back an hour and a half after they had closed, but was in the middle of feeding, didn't hear phone and they didn't leave message.

A week and a half is quite awhile with blood. I don't know if he could become anemic and not able to have surgery if needed. Hoping he isn't already. A couple of times he seemed wobbly. Breathing more noticeably may be discomfort or possibly not enough oxygen getting to all his parts causing him to need to breathe harder to transport enough nutrients? I just checked on him and he had emerged from his hay pile and was standing at his food pile nibbling, so he's not totally lethargic, but did skip over some of his favourite things during the afternoon which he usually would not do.

Doctor said a week ago that sometimes these things settle and that usually blood lost in urine doesn't lead to anemia, but am not sure if she was qualifying longterm blood loss in that statement. At what point does this become dire?

Talishan
You can quote me

Post   » Tue Jul 25, 2017 3:00 am


In my experience (only) -- mild blood loss over a long period of time is (by itself, anyway) no big deal. They make more, same as we do; the loss is not cumulative.

A large amount of blood lost in a short period of time IS dangerous. If you start seeing large areas of bright-red blood on bedding, even things that look like clots -- think like an assault crime scene or a really bad period -- give orange juice and get him to a vet as SOON as possible.

Vets can do a blood test called PCV (I think it means packed cell volume) that essentially gives a RBC count. They'll do this preop to make sure the pig is able to recover from any necessary surgery.

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daveandtiff

Post   » Tue Jul 25, 2017 6:46 am


Okay, thank you, Talishan. Had just put him down a couple of hours ago from feeding and this last time he did not pee/poop as much, so not as much blood seen this time, but hasn't otherwise let up. Not dark red most of the time once it hits blanket, usually pink or brown, but when I watch it stream out of him or when it collects into a puddle it looks pretty red. Maybe it's along the line of the drop of food colouring in water.

We've had some pretty long sessions through the day and he's had some blood during these times and in his cage. He was more tired and less interested this last time so didn't spend as much time working on it, he needs rest. Had eaten fresh things in his cage while waiting for me to prepare new juice. He was 982g an hour and a half ago so we're getting back on track. One thing I'd forgotten to write was his temp taken yesterday at 100.7 and urine test didn't show WBC's, but am regularly checking. His ears have been off/on warm or cool, red or pale. Not sure if a hydration thing or something other.

Can the PCV test be run with smaller amount of blood (could they get enough from a foot pad prick vs a draw?)? Am wondering if we start to worry more about him if this would be a good precautionary test to give us a status on him.

With your thoughts on rapid blood loss, this is the thing I've been considering when wanting to keep blood volume up and with hydrating him. To find some way to control bleeding (right now hoping Lysimachia he's taking is reducing inflammation and the tannin is helping somewhat to constrict vessels that are bleeding, but am wondering if we should try Vit K again, if no contraindications for an elder stone pig?). What I worry about is hypovolemic shock, related heart attack, etc. May try a bit of cooked cream of wheat to increase iron, too.

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daveandtiff

Post   » Tue Jul 25, 2017 8:47 am


A few edits/updates. His weight was taken before feeding (around 3a). Was editing times as had fallen asleep before finishing post and was trying be accurate, but realized later that I had missed editing his weigh-in time in the note, so at this time it looks as though it was taken after feeding, but was not. I looked at cream of wheat a bit more and appears it may also be higher in calcium, so think this is out. And wrapped his foot in a flex bandage to see it would help protect from bumblefoot by changing pace (was nervous that he would try to eat it, but so far so good).

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daveandtiff

Post   » Tue Jul 25, 2017 3:20 pm


Doctor called and said his stone is 6mm. Not sure dimension of his urethra. She said it would most likely sit there, but always a possibility of blockage. Dimensions of his own urethra not known. What are the general dimensions (at smallest/largest points) of male urethra?

bpatters
And got the T-shirt

Post   » Tue Jul 25, 2017 3:52 pm


Six millimeters is very nearly a quarter of an inch. Not likely to pass in a male.

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daveandtiff

Post   » Tue Jul 25, 2017 4:12 pm


Thanks, bpatters. That's what I was figuring, cannot imagine anything in a boy stretching that much. So we will forego shilintong at this point if it might create a greater chance of blockage.

Am thinking of trying to make corn silk juice. It would take alot of it through the juicer, but heard that this can help to "lubricate" sludge/smaller stones to help them to pass through better. At this point, I would like to do whatever possible to make this larger stone less abrasive, not sure if this would work. He eats the silk, but is off/on with it.

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