Louise - stuck bladder stone in urethra

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puffin

Post   » Tue Nov 09, 2021 8:51 am


Hello!
I have a 3-year old sow, Louise, that is having issues with bladder stones. She recently saw an exotic vet when I noticed a little blood in her urine. The vet could see a stone protruding from her urethral opening and an x-ray confirmed a large stone. Louise was given gas sedation and the vet was able to manipulate the stone out successfully. Several days after the procedure, I noticed more blood in the urine and we went back for a recheck. The vet noticed another stone (much smaller compared to what was removed) that she hadn't originally clocked on during the first x-ray. That stone wasn't quite as "bright" on the x-ray and was in the bladder then. During this visit, it had progressed from the bladder through the urethra and because it was so small, the vet thought we could monitor to see if she was able to pass it on her own.

In the week since that visit, she's had some additional blood in her urine but is eating, peeing, drinking normally. We went back yesterday for a recheck and the stone is still in its same location. The vet thought it was worth trying the sedation and manipulation again. She was able to get a tiny piece but the majority of the stone isn't moving. She couldn't get it flushed back into the bladder or get it to move further out. She thought maybe there was some scar tissue from the earlier larger stone that was keeping this little stone stuck.

Louise is on metacam 1x day and we are going back in Friday morning. She will give Louise extra fluids and try expressing her bladder to see if that can help push it along. If that doesn't work, she suggested a referral to a surgeon, but she felt like due to the location of the stone - if it couldn't be pushed back into the bladder - that a surgery on the urethra would be incredibly risky.

The stone is the shape of the grain of rice - I am unsure of the size but will try to get that information from the x-ray on my next visit. My only comparison is the x-ray of the stone that was removed (which was about 0.5 cm width and 0.75 cm long) and this stone is significantly smaller and had a lighter appearance on x-ray (the removed stone was very bright and a solid white color). I am not sure that means anything though!

Louise is showing no signs of distress and is behaving normally. She is peeing fine currently.

Is there anything I could try at home to help move the stone along? Louise is not a big drinker and I am wondering about syringing extra filtered water to increase urine flow. I am offering her wet green leaf lettuce, cucumber, endive, escarole, tomato, and red pepper.

Has anyone experienced a similar situation with a stuck stone? If surgery is not an option - is it possible to be managed with anti-inflammatories and monitoring?

Thank you!

User avatar
Lynx
Celebrate!!!

Post   » Tue Nov 09, 2021 11:36 am


How about trying some shilintong? Yes, to the anti-inflammatories and monitoring.
http://www.guinealynx.info/stones.html

It is certainly possible that there was some scarring or injury from the larger stone that passed. What I hope does not happen is that it stays there for some reason. It sounds like your vets are giving you sound advice.

User avatar
Catie Cavy
Supporter 2011-2020

Post   » Tue Nov 09, 2021 1:46 pm


In addition to the shilintong, you can try a sedative like Ativan or Valium. They act as a muscle relaxant to help pass stones. Other than that, lots of water may be your best bet. Wet her veggies, syringe liquid, and give her fruits and veggies with high water content.

User avatar
puffin

Post   » Tue Nov 09, 2021 2:38 pm


Again, thank you both for your time and kindness! This website has been a godsend to me over the years mothering pigs and bunnies - so much great information and support.

I did read about the shilintong and am intrigued! I guess my biggest worry would be sourcing from a trustworthy entity - I will look to see what vendors others have had good luck with. The sedative is also a good idea.

Louise is not having the water syringing at all! I have added a little bit of unsweetened cranberry juice to entice her but that is also a no. She has been eating wet veggies voraciously though and did accept a very runny critical care slurry. I will keep encouraging her!

Talishan
You can quote me

Post   » Tue Nov 09, 2021 3:24 pm


Another thing you can try -- if you're up for it and Louise will tolerate it -- is administering subcutaneous fluids. The vet can do this, and if you're up for it can show you how to do it and give you the supplies.

Don't push big amounts. I wouldn't go past about 20 cc's at a time for a case like this.

All that said -- if it's not bothering her, and she's eating, drinking, urinating and behaving normally -- I'd just monitor her. If it shifts and starts to block her urine flow, that's an emergency, but this is somewhat less likely to happen in females than in males. You could also have it x-rayed periodically to see if it's growing, shrinking, moving; but if she's comfortable, I'd just monitor her and leave her be.

Good luck and very best wishes in dealing with it to her and to you. Keep us posted!

User avatar
Sef
I dissent.

Post   » Tue Nov 09, 2021 4:28 pm


Go on Amazon.com and search for Shilintong. They carry it. The brand I use is Solstice.

I hope something helps Louise. Stones are worrisome.

User avatar
puffin

Post   » Tue Nov 09, 2021 5:49 pm


Thank you all again! I have done sub-Qs for a rabbit several years ago. It could be worth exploring for Louise. The biggest challenge with my bun was getting her to sit still and it was a traumatic for all of us! I wish I lived closer to the vet (it seems like everywhere I move, the exotic vet is always a 30 minute drive) but I may also ask about bringing her in every couple days for it if I can't muster to fortitude to do it on my own.

Getting x-rays have been really insightful for tracking the stones - is there a general guidance on what is a safe frequency to repeat them?

I appreciate the shilintong recommendation. I've order the Solstice brand sold by Solstice, which should come next week.

I really appreciate all the kind thoughts and advice. I am an anxious piggy owner and all the different options and potential outcomes is overwhelming (especially when I'm dealing with issues in multiple pigs right now!). Thank you for listening!

User avatar
Lynx
Celebrate!!!

Post   » Tue Nov 09, 2021 10:30 pm


There are some subcue techniques explained on this page that might be helpful:
http://www.guinealynx.info/subcue.html

Your vet should be able to advise you on xray frequency if you are concerned.

I hope she can pass it!

Bookfan
For the Love of Pigs

Post   » Thu Nov 11, 2021 10:47 am


The ativan worked well for us - forgot which pig.

User avatar
puffin

Post   » Fri Nov 12, 2021 3:54 pm


Thank you all again for the suggestions. Louise went back to the vet this morning. They gave a sedative and sub-q fluids to try to push the stone, but that didn't do anything. They then put her under the gas sedation to try a catheter flush. The vet was perplexed because they were able to get the catheter up into the bladder with no trouble. She did an x-ray with the cath in and says you can see the fragment there but it doesn't appear to be impeding the urethra or urine flow. She indicated it was a (relatively) large cath, so in that sense, I guess it is a relief that whatever it is isn't causing a blockage. She did a bladder flush and there was some sludgy stuff that they flushed out.

I did notice this morning some very minor pink spots on her fleece from bleeding, so the vet wasn't sure what was causing that. She thought the sludge my have been irritating her or that it could be a case of IC. She is going to do an ultrasound just to rule out any reproductive causes for the bleeding.

She suggesting trying a potassium citrate supplement for sludge/stone prevention. She wasn't familiar with glucosamine supplements for pigs. I have seen the Oxbow biscuits that contain either 45 mg (urinary) or 90 mg (Joint) to get her opinion on. I need to do some reading on here about that as well to get familiar with dosages. Also to use metacam as needed for bleeding.

So I guess sort of good news although I wish we could understand what was going on with the fragment that is lodged there.

I do have a stone that was initially removed from her and have read about stone testing to determine whether it is oxalate or carbonate based. Has anyone had experience with where you would send for testing? If I am recalling something I read, the potassium citrate might be contraindicated for one of the stone chemistries? Although I feel I've read so many different things, I am not sure if I am jumbling my information!

User avatar
Sef
I dissent.

Post   » Fri Nov 12, 2021 6:29 pm


Well, that's somewhat good news! Glad to hear there is no blockage, at least.

It has been a while, but if I remember correctly, potassium citrate is an alkalinizer and generally not recommended for guinea pigs---their urine is already highly alkaline (did your vet test pH?). Someone here can correct me if I'm off-base.

UC Davis did a study a few years back and determined that more than 95% of all guinea pig stones tested (and it was a fairly high number in the study) were calcium carbonate in make-up. Oxalates aren't as common in guinea pigs, although they do occur. My vet has been of the opinion in recent years that testing is a waste of time/money since the several we have tested in the past have indeed been carbonate, and we treat the same way regardless---increase fluids, reduce overall dietary calcium, used filtered water, encourage increased activity to try to combat sludge, etc. Some pigs still have recurrences, regardless. Genetics apparently also play a role in all of this, and some pigs are just naturally prone. That said, I can try to look back through some of my old notes as I'm thinking there used to be a lab somewhere in Michigan that has been recommended?

What kind of pellets does she get?

User avatar
Lynx
Celebrate!!!

Post   » Fri Nov 12, 2021 7:13 pm


Sef gave a great summary! Sef was instrumental in getting the stones page up.
I suspect that the insertion of the catheter and process of flushing irritated the urethra, perhaps slightly abrading it, and is the cause of the pink urine you are seeing.

daj

Post   » Sat Nov 13, 2021 11:49 am


I have a male who had stones, and I think we are now dealing with a repeat occurrence. I use the Solstice brand shilintong. At night I mix up one tablet broken up, in 8 oz. water, in an 8 oz. Ball jar. I add a spoonful of pellets and a sweetener like cantaloupe juice or molasses. My pig loves the mixture. 8 oz. is a lot of fluid to syringe. I give it 4 times per day from a syringe w/ the tip cut off so it's just an open tube. To reduce the syringing, at each feeding I chop hay and soak it in the mixture in a little metal cat bowl. Another trick I just realized is to pulverize some hay into a flour and add a couple of pinches of this to the mix. It helps soak up liquid, and my pig can eat that wet mixture on his own without me having to syringe so much. He successfully passed his two stones, and he loves his diet..

I also cut way back on the vegetables I give. I stopped giving him greens altogether. I assume a lower mineral content diet is best for a pig prone to stones. My pig just does not drink much on his own. After a year I began thinking I could slack off on this routine, and I even started giving him a little lettuce again. I was only syringing fluid once per day. Within weeks he had blood in his urine again. I went right back to the routine that was successful the first time. The blood has persisted though. I took him to the vet, and he is now on an antibiotic to address what I hope is just lingering infection. If his blood doesn't clear up after a week I will have to get him x-rayed again. I feel OK holding off on the x-ray for now while he's getting a very high fluid diet, and he is as lively as can be.

User avatar
puffin

Post   » Sat Nov 13, 2021 1:54 pm


@sef - the vet ended up opting not to try the potassium citrate after doing a little reading (sounds like that is in line with what you've discovered with your vet). She suggested doing the Oxbow urinary biscuit for now as a supplement. For pellets, I had originally been doing the Oxbow red bag, then was doing a mix of that and Sherwood (the formulation with no alfalfa). Now, I've got the Oxbow Garden, which I have been giving about 1/4 cup for 3 pigs to share. I would like to skip pellets altogether or maybe just go sporadically on days when I can't get the pigs out in the sun for a bit for Vit D. It probably isn't worth digging up the notes for the stone testing just now. I have connections to a geology department here and I can probably entice them to test the stone for me if need be!

@lynx - I hope the bleeding is just residual from all the poking with the catheter. Seeing the little pink spots on the fleece is one thing, but last Saturday, Louise was up on me and peed and it was bright red. I about lost it in panic, calling emergency vets (none had exotics on staff). My husband talked me off the ledge and once the pee dried, it looked much less menacing.

@daj - Thank you so much for your post! My (Solstice) shilintong just arrived today and I was apprehensive about what to actually do with it! Your recipe sounds great, especially for hydrating a pig that is not a big drinker (Louise is the same). The little bottle has the human serving at "5 tablets two to three times daily" with 5 tablets = 1.75g Desmodium. Is that the dosage you have (I know you are giving one tablet per day - I'm just paranoid about giving too much). That is really good to know about the greens as well. I have been unsure about giving them (they give hydration but are they making things worse). I am sending good thoughts that your piggie gets feeling better and there is no recurrence of stones. You are doing an amazing job helping him!

daj

Post   » Sat Nov 13, 2021 3:29 pm


Yes, that's the stuff. It seems quite safe to me, as I'm probably on my 3rd bottle with Jack. On the issue of greens, I am influenced by another experience with my pigs who are all hairless. They had horrible itching and lesion or scab like patches on their backs. It went on for about 2 years, I think. I went through a million different treatments, and 3 different vets. It was agonizing and expensive. After all the suffering, it all went away within a week when I cut out all greens except a bit of green leaf lettuce each day. Even vets recommended things like parsley, cilantro and the like for the fatty acids to help their skin. That's partly why it was so confusing. It wasn't until I stopped with the grass, the artichoke, the whatever else that's green that all our skin issues resolved. I just came to feel that pigs don't need a lot of greens, and very small amounts of any other fruits and vegetables. Anyway, that is just my 2 cents. Hoping for the best for your piggy too!

Talishan
You can quote me

Post   » Sat Nov 13, 2021 3:38 pm


If a fairly large (for a guinea pig) catheter didn't dislodge it, I'd be really inclined just to monitor.

If it moves and begins to block her, she will let you know, and that is a true emergency. Monitor and stay alert. But if a catheter didn't budge it, I'd take a small (qualified ;-) sigh of relief and just keep a close eye on her for now, along with the other suggestions here.

User avatar
Lynx
Celebrate!!!

Post   » Sat Nov 13, 2021 7:43 pm


Just a note that guinea pigs need to be in direct sunlight to get any vitamin D. If they are inside, windows block it.

User avatar
puffin

Post   » Thu Nov 18, 2021 11:07 am


Louise has done well this week. We stopped the metacam on Monday (the vet wanted to use it as needed if we saw blood). So far, no blood! Louise hasn't seemed quite as peppy without the metacam but I may just be projecting my anxiety onto her behavior. It is a little colder outside (and thus in our house) and I don't think she is a fan of that! When it has been nice, I've been trying to get her in direct sun for 10-15 mins. I am syringing the shilintong water, but I think I will have to try to make a slurry ro something because there is a lot of water!

User avatar
Lynx
Celebrate!!!

Post   » Thu Nov 18, 2021 11:46 pm


Encouraging news! I hope she continues to do well and that the shilintong helps.

User avatar
puffin

Post   » Sun Nov 21, 2021 5:39 pm


I have made the shilintong a bit more concentrated (1 pill to 100 ml water) and she is really liking it. I took a taste and it has a sort of slightly sweet celery flavor. I offer a syringe to her throughout the day and she is drinking maybe 5 mls at a time without me having to force her (I think she had about 20 mls of it today). I've also reduced her greens intake too because of the stones, and I see her in the hay more, and thus drinking more water. So hopefully she is getting flushed out more!

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