Hydrochlorothiazide treatment for chronic calcium in bladder

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Post   » Mon Oct 26, 2015 9:21 am

I just wanted to share with you an interesting new treatment my vet has tried for chronic cases of calcium deposits in the bladder.

I have a 5 y/o female, intact, english smooth (Lucy) who has had issues with bladder sludge/stone and UTI for the past 3 1/2 years. She has had several UTIs in that time expected to be caused by a combination of age/decreased grooming (she also has crusty/flaky nipples which seem to indicate decreased grooming) and bladder stones/sludge. She has been on 0.4 ml sodium citrate and 0.3 tramadol twice a day and 0.25ml metacam once a day since diagnosis. However, these medications did not seem sufficient to keep the UTIs at bay and she had several severe episodes of UTIs where she was kept over night at the hospital and things looked very bleak.

Approx 1/2 a year ago my vet team proposed an investigatory treatment on Hydrocholothiazide 0.1 ml twice daily. This treatment has not been trialled in guinea pigs at my vet (Cornell animal hospital), and have been trialled in rabbits only very minimally. We went forward because the dangers were fairly low and Lucy's condition very dangerous.

It's still early but the results of this med have been pretty amazing. No UTIs since she started on it, decreased pain, some weight gain (after losing weight due to UTIs) and much less accumulation around the anus and vagina (which was prominent when she had UTIs). Her last ultrasound showed decreased amounts of calcium in the bladder.

I can post the full vet report if it would be useful. We have to monitor for decreased phosphorous due to the drug which has us coming in every 3-4 months for blood levels. There has been a small decrease but not enough to worry us currently. If it drops further we will alter the medication amount to try to find a sweet spot.

I wonder whether anyone else has heard of this treatment? And I just thought it would be useful to post.

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Supporting my GL Habit

Post   » Mon Oct 26, 2015 9:45 am

Yes. Pinniped was on that for months, and it looked like it was working, but she died from other issues before we could see the stones completely disappear. Pinniped's Medical Thread

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Post   » Mon Oct 26, 2015 9:53 am

Oh, I think I know Pinni from facebook...?

Thanks for the reference. Looks like the hydrochlorothiazide (I am also impressed that I can now spell and pronounce that without aid!) was working for the sludge issue. I'm so sorry you lost her after such an intense battle.

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Post   » Mon Oct 26, 2015 10:23 am

I added links to this post and yours too, PooksiedAnimals:

If her nipples are crusty, ph08fhf, there may be some reproductive issues going on. See gl/ovarian_cysts.html

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Post   » Mon Oct 26, 2015 1:58 pm

Ditto Lynx.

I'll ask my vet about this next time I see her. Thanks for the information.

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Post   » Mon Oct 26, 2015 4:18 pm

Lucy has a presumptive diagnosis of ovarian cysts (palpated). We aren't so worried about those because they are not noticeably increasing in size.

Perhaps that's not wise, and I should be trying to treat/zero in on the ovarian cysts...? Here's my reasoning behind not doing so:
i) Lucy is old enough that I'd prefer not to do too many exploratory tests.
ii) ovarian cysts aren't causing any obvious problems
iii) she is finally on a treatment for the sludge that it working and I'm nervous to 'upset the apple cart'
iv) Lucy has recently been diagnosed with a new, fluid filled, splenic mass which I want to keep an eye on and not disturb if possible (for fear of 'bursting')...

Let me know if you want detailed blood levels following hydrochlorothiazide prescription.

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Post   » Mon Oct 26, 2015 9:20 pm

Sounds reasonable not to focus on the possible ovarian cysts. From your description, my biggest worry would be the splenic mass.

Any details you wish to add are welcome.

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Post   » Mon Oct 26, 2015 9:41 pm

I'm very worried about the splenic mass. Trying not to think too much about it. They plan to monitor it via ultra sound again next time we are in. I'm really unsure whether to do anything more aggressive (i.e. drawing the fluid etc).

I will post full vet reports soon for Lucy to document the treatment for posterity, and in case anyone else would like to discuss the option with their vet.

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Supporter in '13

Post   » Wed Oct 28, 2015 11:09 am

Jaycey has used thiazide diuretics with Anselmo. Anselmo's thread

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Supporter in 2014

Post   » Thu Oct 29, 2015 11:45 am

Sorry that I never commented. I'm dreadful with medicine names so had no idea that it was a similar thing!

He's been on it since January 2015 and at the moment I'd say that it's not a miracle cure as he still has calcium spots on his bedding and needs to be cleaned, but on the other hand *touches wood* he doesn't have any signs of new stones forming.

We've not taken any new xrays since October 2014 so we only have outward signs to base any opinions off at the moment.

I'm happy to let you have my vets details if you want to email them and ask their opinions of the tablets Anselmo has.

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Post   » Thu Jun 09, 2016 2:14 pm

I am beside myself with Lucy's condition. I am hoping you all can help me to find a little bit of clarity.

Lucy has multiple tumours and advanced arthritis in her hips. She also has bumble foot.

On tuesday night (the 7th) she was gassy and I rushed her into the ER. They kept her in overnight, gave her fluids, fed her etc. She was discharged the following day.

Lat night (the 8th) her breathing became elevated and she was moving a lot less.

Since last night she mostly sits in the one position breathing hard. She eats a little on her own, and will wolf down critical care when it's offered to her on a spoon. But she isn;t moving around, and when I have her in my lap I can see that she is shivering intermittently.

I feel she doesn't have long left I'm very worried that she's in pain. She is taking 0.6ml of metacam once a day, 0.45ml of tramadol twice a day and 0.1 ml of gabapentine 3 times a day. She is at the max for pain meds.

On top of that, I go out of town on monday for work and I'll be a way for three weeks (my partner will be caring for her).

I am wondering whether it is time to let her go. But every time I think about it i feel guilty and sick. On the one hand she may be in pain and it may make a difference for me to be there. On the other hand, do I know that she is in a lot of pain? And given how she wolfs down critical care, can I be sure that her quality of life is so low.

I am in a complete state about this. And I really feel like i am running out of time to make the decision.

Any guidance or thoughts would be so welcome. I know this is my decision that I must make myself, but I feel do lost right now.

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Post   » Thu Jun 09, 2016 3:25 pm

I am so sorry she is so ill. Have you talked to your partner about the decision? Are the tumors interfering with her ability to breath? Have you recently talked to your vet about her prognosis?

That you feel she is in pain says a lot to me. From your description the prognosis is very poor.

This is such a personal decision. I wish I could offer better advice.

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Post   » Thu Jun 09, 2016 3:34 pm

I'm sorry she's having such problems.

It's a very personal decision to have to make, and every one comes to it with a different perspective. When faced with a crisis this serious, I usually opt for euthanasia sooner rather than later. Pets don't understand time the way we do, and I never want one of mine to suffer in any way just so I can postpone the inevitable for a few days or even a few weeks. I can live with letting them go too soon better than I can with knowing they may have suffered because I wanted to keep them a while longer.

But you're the one who's there with her and who has to deal with it. Sending good thoughts for you and Lucy.

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Post   » Thu Jun 09, 2016 3:49 pm

I spoke to my vet shortly after posting. The breathing issues could be pain related, or it could be that the cancer has metastasized to her lungs. The prognosis is very poor. The vet agrees that its unlikely she will live 3 more weeks. When we first discovered the masses we agreed that we wouldn't pursue aggressive treatment options (given her past health issues).

She struggles to even to lie down with her arthritis and foot problems. She seems to be more comfortable in my lap and has even been able to fall asleep a couple of times (properly, with ears and whiskers twitching).

(sorry for any typos, I'm typing one-handed so that I don't disturb her).

I've made an appointment for tomorrow afternoon, with the knowledge that I can cancel if it feels really wrong.


Post   » Thu Jun 09, 2016 4:25 pm

I'm sorry you have come to have to think about making a choice.

I will say this. When my Star had made it as long as she could and nothing made her better and she was suffering, I knew what the right thing to do was. But even knowing that, I felt so conflicted. It is never an easy thing. I had to remind myself that keeping her alive beyond that point was selfish, it would be for me and not for her benefit.

Even during that final vet visit I had to fight the urge to scoop her up and run. I had prepared myself for that moment but it didn't make it any easier. So it is totally normal to feel so conflicted even when you are sure in your decision.

After some mourning, I felt the relief in knowing she wasn't in pain anymore and that she was running free.

Only you can make this choice, it is never easy, not even when you think you have known it may be a possibility. I wish you the best.

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Supporting my GL Habit

Post   » Thu Jun 09, 2016 8:00 pm

That is always such a hard choice to make. I'm sorry you're faced with this.

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Post   » Fri Jun 10, 2016 4:35 am

The only question I'd ask is how comfortable would your partner be in making a tough decision if necessary?

If she's still eating well, and is not in constant, unremitting, acute pain, as far as you can tell, if it were me I'd not yet make the last appointment.

That said -- if your partner is in tune with her, has a feel for how she feels, and could make a tough decision if it felt right while you're out of town.

If your partner isn't at that place, or would not be comfortable with (well, as 'comfortable' as any of us can be) or able to make such a decision and take her in if necessary while you're gone, then it might be better before you leave.

I'm 'slightly on the other side of the dividing line' from bpatters. I'll tend to err on the side of going a little longer rather than sooner. If it's not something you feel you could, or should, leave to your partner, however, then that would make the difference with me.

Blessings, comfort and peace to Lucy and to you regardless.

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Post   » Fri Jun 10, 2016 2:11 pm

I'm still not sure what to do.

Lucy seems a little brighter today. She wheeked for food this morning, and has maintained a good appetite throughout. She ate a bunch of melon (3 different varieties - of course she wanted to take a few bites of each piece rather than finishing and one whole piece...) and we had a long cuddle with her falling asleep in my arms multiple times.

She is still gassy, and she has trouble walking around and defecating. She doesn't move much and has periods where she sits hunched. In addition, her breathing is still laboured.

When I sit with her in my lap, she seems quite contented and especially when she eats. Seeing her like that makes it hard for me to think I should euthanize. But other times her lack of movement and laboured breathing concern me.

I've always felt like I have a sense for what my pigs need, but not now. I just wish she could somehow tell me what she wants.

I have the vets appointment in an hour. My plan is to go to that and try to get a better understanding of what exactly is happening in her body and what she is feeling. Is she more relaxed in my arms because she is enjoying a good cuddle like she always used to? Or is it because, being a prey animal, she is very aware that she is sick and is just glad of the protection... Is she breathing laboured because she is in pain? Is there pressure on the lungs? What does that feel like? Is it scary?

To make things even more confusing - her feet (which have had some nasty bumblefoot for a long time now) look better than ever (i've stopped with the bandages and started using agricultural 'blue kote')...

In addition i was us crying with her till 3am last night and my head is throbbing, so decision making is particularly difficult...

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Supporter in '14

Post   » Fri Jun 10, 2016 6:21 pm

I am very sorry you are faced with such a hard decision. My heart goes out to you. Going away must add even more stress to an already stressful situation. In your situation I would feel pressured to make a decision before Monday rather than being able to take a day at a time. That being said I am the only one that would know when the time is right to say goodbye.

I am hoping that your partner feels comfortable taking one day at a time while you are away so you don't have to commit to a decision you are not ready to make.

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Post   » Fri Jun 10, 2016 10:44 pm

You have my best wishes in this hard time.

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