[Stones] UTI

[Candy G.]

Greetings, Joel -

I was so sorry to read of Star's problems.  These little ones can bear a lot 
with grace and poise.  Sometimes, I believe that makes it even more 
heartbreaking.

I don't know if anything that I have to offer will help, but I have had some 
of the same things go on with my female, Mollie, that you are experiencing 
with Star.  Maybe you might see something in this that will ring a bell.  
This is a really LONG post, but - having been through so much of this myself 
with Mollie - I am going to include anything I think might even be of a tiny 
little potential for help.  I know that when I first was exposed to this 
Bladder Stone Hell, I was frantic for ANY information at all from ANYWHERE.  
So, apologies for the length, okay?

[Note:  Also, the Stone Digest Archives are a TREMENDOUS resource for great 
information.  Thank you, thank you, thank you, Tex for pointing me in that 
direction a few months ago.]

ANTIBIOTICS AND WEIGHT LOSS:  While Star was on the Baytril, did you also 
give her some sort of probiotics to counteract the antibiotic affect on her 
gut flora?  If so, then skip the rest of this paragraph.  If not, then here 
is what I have learned (it is a wonder that my initial ignorance hasn't 
killed both of my piggies!).  Because of the tendency for bloat in piggies 
and also because of the nature of the way their GI tracts provide nutrients, 
it is really important that the normal flora remain as intact as possible.  
Antibiotics really screw that up.  The probiotics help to correct it.  There 
are several probiotics that will work and also some folks give their piggies 
acidophilus capsules.  I have found that the probiotic paste works best for 
Mollie.  There is one called Bene-Bac Gel.  I have heard of it, but not used 
it.  The one I use is called Probios.  It is put out by Vets Plus, Inc.  I 
believe their web site is www.probios.com.  This is easily found at the 
local Feed, Grain, and Hardware store (such as Wilco, etc.).  I use the 30g 
syringe form of the Equine One gel.  There is a powdered version that 
specifically states that it can be used for small animals, but it is exactly 
the same ingredients as the gel and the dosages are the same as well 
(however, this could be sprinkled on Star's fresh veggies).  The gel, to me, 
is much more convenient.  I use "a smidgen" - about the equivilent of 1/4 
teaspoon - which is about 1/2 turn of the collar-lock that is on the 
syringe.  It doesn't take but just a little bit for piggies.  I give it 
approximately 2 hours after giving Mollie the antibiotic.  I am wondering if 
Star's off-kilter eating and weight loss could possibly have anything to do 
with her GI tract being out of whack?  SUMMARY:  if she is on antibiotics, 
make sure that you replace the normal gut flora 2-3 hours after EACH dose of 
antibiotics.

METACAM:  Are you sure that the Metacam dosage is sufficient for her size?  
Mollie sees an extraordinary exotics vet - she is wonderful with piggies!  
You listed Star's dosage as .02 ml.  The dosage that Mollie was initially on 
when she had such severe inflammation was .7 ml (not .07 ml) once a day.  
That was to produce a "burst" effect - really saturate her system with the 
med to knock down the most severe inflammation.  Her maintenance dose right 
now is .4 ml (not .04 ml) once a day.  Mollie weighs approximately 1000 
grams.  Even with the weight difference between Star and Mollie, that is 
quite a difference in dosages.  Is it possible that Star is not getting a 
therapeutic dose and therefore not getting true relief from the 
inflammation?  SUMMARY:  Ask your vet to verify the correct dosage for 
Star's weight and size.

BAYTRIL and BACTRIM:  Has your vet actually done a urine culture to see 
exactly what bacteria may be causing the infection?  This is an important 
piece of information for Star's recovery.  Different antibiotics act on 
different bacteria in different ways.  What is used for one may not be 
useful for another.  The reason I say this is because, in an emergency 
situation, I took Mollie to our regular vet (our cat vet) because he was 40 
minutes away and our exotics vet is two hours away.  He did a urine culture 
and put Mollie on Baytril.  Two weeks of oral Baytril didn't work.  Two 
weeks of low dose injections (subcutaneous) of Baytril didn't work.  Two 
week of high dose injections of Baytril seemed, at first, to have worked.  I 
had stuck with the vet because he was really working hard to get Mollie well 
and I didn't want to "offend" him by switching, in mid-stream of the 
situation, back to our exotics vet.  **This ended up being a stupid and 
costly decision!**  Six weeks after we thought that Mollie was finally over 
the UTI, it came back with a vengence and she was really sick and in pain.  
I took her to the exotics vet and she cultured her urine.  It came back as a 
Pseudomonas infection.  While Baytril is the antibiotic of choice for 
piggies and a fantastic drug for them, it does not touch Pseudomonas in any 
way.  My exotics vet knew this immediately.  I had just put Mollie through 
six weeks of antibiotics for NOTHING.  Four of those weeks included 
injections twice a day which were painful for her and did tissue damage.  
And, I had wasted six weeks when she could have been getting better if she 
had been on the correct med.!  I felt so guilty!!!  Pseudomonas is 
notoriously difficult to get rid of, both in humans and in other animals.  
The Pseudomonas drug of choice for piggies is Ciprofloxin (aka Cipro).  This 
is the same drug that is given for anthrax exposure.  You need to make sure 
that you know what the UTI bacteria specifically is and that Star is being 
given the proper antibiotic for that bacteria.  SUMMARY:  A urine culture is 
ESSENTIAL in order to make sure you are giving the proper antibiotic and 
dosage for the SPECIFIC bacteria.

BLADDER STONES:  The next thing you mentioned, I believe, was that 
originally stones showed up on x-ray, and then they didn't; but then one 
showed up on ultrasound.  I'll tell you, these bladder stones are pesky 
things!  The stones that you saw on x-ray consisted of a material that 
showed up "solid" on film.  That is how they usually show up.  However, 
there can also be "hidden" or "occult" stones which do not show up on x-ray. 
  They are called radiolucent stones and consist of a material that appears 
translucent on film (or digital).  Ultrasound can almost always catch these 
occult stones.  The stones, particularly the big ones, can certainly cause 
pain and hematuria.  Some days, the hematuria can be quite light or visibly 
non-existent; other days it seems that the urine is solid blood.  That is a 
mystery with Mollie that we have not solved and I do not know the answer to 
that.  It could be that the stone is moving around in the bladder and 
causing the bladder lining to bleed; or it could be that the stone has moved 
into the urethra and is increasing the pain and inflammation.  If the stone 
is NOT lodged in her urethra, then it is my understanding that you can take 
some time for treatment and see if it can be dealt with without surgery.  
However, if the stone is lodged in the urethra, that can cause a blockage 
and can be fatal either quickly or eventually due to the blockage.  
Sometimes, bladder stones can be flushed out of the bladder or urethra 
without doing surgery.  I would only trust a vet that is VERY familiar with 
piggie anatomy to try this (or to do surgery, either, for that matter).  
SUMMARY:  1) Try to determine the size and location of the stone(s) to see 
if an irrigation (or "flush") is an option that might be an alternative to 
surgery.  2)  Be on the alert for a blocked urethra - that can become an 
emergency very quickly.

SHILINTONG:  In cats and dogs, bladder stones are almost totally diet 
related.  Usually, with a change of diet, the stone problem can be managed 
successfully.  However (of course!!), there are studies that show that in 
guinea pigs, stones are also related to the size of the urethra.  If the 
urethra is of normal size, then no stones.  If it is small, then stones.  
Shilintong is an herb that is used in humans to 'relax' the urethra and make 
it more pliable and condusive to allowing smaller stones to pass before 
becoming large stones.  A good many people use it for their piggies and feel 
that they have had great success with it.  I have started using it for 
Mollie.  If you are not familiar with Shilintong and want further 
information on it, send me an email and I will send you the info that I 
have, including ordering information.  SUMMARY:  A low calcium diet is 
recommended for "stone piggies", but stone formation can also be connected 
with urethral size.

HEMATURIA, INFLAMMATION, PAIN, AND "STONES":  I will add this note here:  We 
thought that Mollie had a second bladder stone a couple of months ago.  She 
had the classic signs - the same ones that you have mentioned with Star.  On 
x-ray, there it was.  Although the first stones had been flushed out of her 
urethra without surgery, this stone was high in the bladder and fairly 
large.  We decided on surgery.  Shocker:  When they got into the bladder, 
there was no stone.  What had looked like a stone on x-ray was, in fact, a 
BIG clot of blood, sludge, and mucoid  infection material.  Pseudomonas is 
noted for forming mucous-like 'clumps' of infection, but I saw the x-ray and 
it looked EXACTLY like a stone.  SUMMARY:  Just a 'heads-up' that things 
aren't always what they appear to be.  (Addt'l note:  Mollie does now have a 
second bladder stone, bless her heart.)

PAIN MANAGEMENT:  As you are unfortunately witnessing, piggies can feel pain 
just like the rest of us.  Sometimes, in situations such as Star is 
experiencing, anti-inflammatories are not enough to take care of the 
discomfort.  A common pain medication that is used for piggies is 
butorphanol (most common brand name is Torbugesic).  I use it orally PRN (as 
needed) for Mollie and it works very well for her.  I do use it sparingly 
because, even though it is a synthetic opiate, it can still cause a 
slow-down of the GI tract.  As mentioned earlier, the GI tract is a 
delicately balanced system and I don't want to cause constipation on top of 
everything else that is going on.  Mollie has had no ill side effects from 
this medication and it has helped her a lot.  Do you think this might be 
something that would help Star?  SUMMARY:  Although anti-inflammatories can 
be of great value with pain management (as well as inflammation), sometimes 
a true analgesic is also beneficial.

EATS NO HAY OR DRIED FOOD:  This could absolutely be caused by Star being 
ill and stressed out.  It takes practically nothing to get a piggie out of 
whack food-wise (for example - any day ending in a "y" - ha).  But, are you 
sure that her teeth, particularly her molars, are okay?  If she is staying 
away from the harder or more chew-intensive stuff, it could be that her 
molars are overgrown (or there could be an infection at the bone line) and 
it hurts her tongue and teeth to chew anything with any substance to it.  
Has your vet really gotten a good look at her back teeth, and are her front 
teeth in tact and  properly aligned?  SUMMARY:  Tooth problems are an easy 
thing to miss because it is difficult to see the back teeth.

CRITICAL CARE (OXBOW?):  So far, I have never had to use this, but I have 
heard several other piggie people say that their piggies are not fond at all 
of the 'anise' flavor, but that once they switched them to the banana (I 
think) flavor, they did fine with it.  I don't know if this has any meaning 
for you, but I just thought I'd toss it in for good measure.   :)

OVARIAN AND PANCREATIC MASSES:  I have no experience with this (thank 
goodness).  Bless Star's heart, she is really in the ringer right now.  I am 
so sorry.  I do know, from human experience, that a pancreatic tumor can 
cause a cascade of other system symptoms.  And, I know that - with clean 
surgical margins - the adenocarcinoma shouldn't be a problem.  These 
situations add to your already-difficult decision making process of what to 
do.  Wouldn't it be wonderful if we had just the right magic words to say 
that would make our little ones healthy again?  I hope that someone will 
give you solid information on this situation.

WHAT TO DO???? ~~~~~You wrote: "On the other hand, she is not lethargic, but 
is alert, friendly, and playful, so it is hard to imagine putting her down. 
And on the third hand, if we can't get a handle on the infection and we 
can't get her eating again, will we be putting her in a position of pain and 
suffering?"~~~~~~  I cannot tell you the lump in my throat and the knot in 
my stomach that came with reading these words.  This is the bottom line, 
isn't it?  I have faced - and now am facing again - the same situation with 
Mollie.  She is active, alert, eating and drinking, loving and playful.  But 
yet, I can see that she is in pain at times and off-kilter.  How much is 
enough?  How many surgeries are too many?  Right now, we are 'watching' the 
stone.  She is back on Cipro (followed 2hrs later by probiotics) and 
Metacam, plus the Torbugesic PRN.  I am continuing with the Shilintong.  In 
a month, we will see what her urine cultures out and whether or not the 
stone has changed.  In the meantime, I continue to wonder whether or not I 
am doing the best I can by her.  My heart goes out to you in the decisions 
you are having to make.  They are not easy and I don't know that we ever 
feel that we really and truly made the best ones, that there is not 
something we are 'missing' or could have done better.

You and little Star will be in my heart and thoughts.  Please, if you don't 
mind, let me know how she is doing and what you are doing for her.  I really 
am interested in how she is doing, and also something you tell me might be 
the very thing that would help my dear little MollieBug.  Sharing our 
experiences and helping our little ones is what it's all about, really.

Please give Star's furry little head a soft kiss for me.  I am wishing you 
the very best of luck in your continuing efforts to be a conscientious, 
loving, and compassionate 'dad'.  She is a very lucky piggie to have you.

Candy; Topper and Mollie

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
About 2 weeks ago our 5 year old female guinea pig (Star) started crying
when she peed. The vet did an x-ray and said there were very tiny
bladder stones, not blocking anything and perhaps that was causing
inflamation and infection. She was put on 1 week of baytril and metacam.
She stopped eating and lost a lot of weight. We started feeding her
Oxbow intensive care, and afer a week on bytril showed no improvement,
we took her off antibiotics for 1 week, intending to do a urine culture.
half way through that week a second x-ray showed no stones but there was
much more blood in the urine. At the end of the week an ultrasound
showed(?) a bladder stone not visible in the x-ray, a possible mass on
the pancreas and very small ovarian cysts. Vet says cysts not a problem
now but may grow large later. says pancreatic mass might be tumor, or
might be benign, or might be abcess. says the bladder stone is likely
the cause of her current distress and hematuria (why didn't it show up
on x-rays?)

We switched to bactrim ( 0.6 ml given twice a day , now on the 4th day),
continuing with metacam (0.02 ml per day ... that's 0.02 ml, not 0.2 ml)
and continuing with oxbow critical care. weight has dropped from 980
grams when this started to 800 grams now. seems to be stable at 800
grams for the last few days. she still eats almost no hay and no dried
food. will only eat fresh greens (carrot greens, parsley, lettuce,
cabbage, etc) and will only take critical care through the syringe --
(under protest). She is still alert and playful... just won't eat and
squeals when she pees. I still see red in the urine ... some days just a
little and some days a lot.

The vet says if we do decide to operate we should attack all three
issues : bladder, ovaries, pancreas and says that is asking a lot of an
elderly animal who has lost so much weight. On the other hand, she is
not lethargic, but is alert, friendly, and playful, so it is hard to
imagine putting her down. And on the third hand, if we can't get a
handle on the infection and we can't get her eating again, will we be
putting her in a position of pain and suffering?

Has anyone seen a similar case history and do you have some advice for
one confused cavy owner.

P.S. The one other health concern is that she had a growth behind her
ear about a year ago, which was removed (clear margines,
adenocarcinoma). It came back about 4 months ago and was removed again
(no pathology done at that time). So far there is no indication of any
recurrence .

Thanks for any help, sympathy, or advice.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~