Bladder Flush Via Catheterization For Stones

[Shannon R]

Hi everyone,

I very stuck on what to do with my guinea pig Spike. We are located in an area were we don't have access to many vets with exotic expertise. I rescued Spike and Marbles(his brother) from the SPCA last April. I started to notice quickly that he hunched while he peed(no noise) and had frequent urination with small amounts, which was unlike his brother Marbles. Long story short, I eventually called a local vet who said she did see a couple guinea pigs. She has been great. We did an x-ray at the time(last fall) and nothing could be seen. We went on to do a trial of antibiotics to see if it was an infection and they did not help so we ended up sending off cultures(had to send across the country). It came back negative. From that time until now we have ended up doing a couple cultures and x-rays, all of which were negative. We also tried gabapentin for possible idiopathic cystitis for Spike continued to hunch with frequent small amount of urine and also started to squeal a bit. Two weeks ago we decided to go ahead and catheterize him to flush out any small stones that would not be seen on x-ray. Two very small stones ended up coming out during that process. He has been on Meloxicam for the past two weeks and was one antibiotics(Baytril/Enrofloxacin) after the procedure for one week. One week post procedure he was still squealing quite badly, hunching up in pain and there was pee in his urine. His urine smells very foul and when he does hunch up you can see spasms of his back end(both with pee and poo)

My vet is at a bit of a lost of what to do next. We think it could be 1) infection from being catheterized and that the bacteria was not susceptible to the prescribed antibiotic 2) there is another small stone that did not come out the first time. My dilemma now is 1)do I do culture and sensitivity(this will take 4 days) or treat prophylactically with antibiotics OR 2)do I go ahead with another catheterization procedure(currently have this booked for tomorrow). I am nervous to wait 4 days for C & S but I am also nervous about re-catheterizing Spike so soon(Last time was April 27th). I have tried to get advice from vets in the next province but they are not allowed to consult to different provinces.

I was wondering if anyone has had anything like this happen and if they have any advice on what I should do next. Thanks!

 

[Wiebke]

Hi everyone,

I very stuck on what to do with my guinea pig Spike. We are located in an area were we don't have access to many vets with exotic expertise. I rescued Spike and Marbles(his brother) from the SPCA last April. I started to notice quickly that he hunched while he peed(no noise) and had frequent urination with small amounts, which was unlike his brother Marbles. Long story short, I eventually called a local vet who said she did see a couple guinea pigs. She has been great. We did an x-ray at the time(last fall) and nothing could be seen. We went on to do a trial of antibiotics to see if it was an infection and they did not help so we ended up sending off cultures(had to send across the country). It came back negative. From that time until now we have ended up doing a couple cultures and x-rays, all of which were negative. We also tried gabapentin for possible idiopathic cystitis for Spike continued to hunch with frequent small amount of urine and also started to squeal a bit. Two weeks ago we decided to go ahead and catheterize him to flush out any small stones that would not be seen on x-ray. Two very small stones ended up coming out during that process. He has been on Meloxicam for the past two weeks and was one antibiotics(Baytril/Enrofloxacin) after the procedure for one week. One week post procedure he was still squealing quite badly, hunching up in pain and there was pee in his urine. His urine smells very foul and when he does hunch up you can see spasms of his back end(both with pee and poo)

My vet is at a bit of a lost of what to do next. We think it could be 1) infection from being catheterized and that the bacteria was not susceptible to the prescribed antibiotic 2) there is another small stone that did not come out the first time. My dilemma now is 1)do I do culture and sensitivity(this will take 4 days) or treat prophylactically with antibiotics OR 2)do I go ahead with another catheterization procedure(currently have this booked for tomorrow). I am nervous to wait 4 days for C & S but I am also nervous about re-catheterizing Spike so soon(Last time was April 27th). I have tried to get advice from vets in the next province but they are not allowed to consult to different provinces.

I was wondering if anyone has had anything like this happen and if they have any advice on what I should do next. Thanks!

Hi and welcome

Are you Canadian? Please add your country and province to your details, so we can tailor any advice to what is relevant where you live straight away. We have members from all over the world. You can make your location appear underneath your username in every post you make by clicking on your username on the top bar, then going to personal details and scrolling down to location. Thank you!

The smell and frequent urination very much points to an infection indeed.
Septrin/bactrim (sulfamethoxazole and trimethoprim) is usually the antibiotic that is working best for urinary tract issues, but it needs to be given for longer to be most effective. There are other, even stronger antibiotics that can be given to guinea pigs. Your vet may want to have the bacteria cultured to find the correct antibiotic; but she needs to make sure that any antibiotic is safe to use with guinea pigs.
Guinea Lynx :: Antibiotics
Guinea Lynx :: Dangerous Medications

Please continue with the metacam.

Bladder flushes need to be done very, very gently and carefully to prevent any fluid backing up into the kidneys. Baytril is often not strong enough to cut through bladder problems. What dosage/weight is your boy on?

I am tagging in our medically most experienced members for you although you may need to wait until tomorrow because of the time difference, as most are UK based.
@helen105281 @Jaycey @furryfriends (TEAS) @Freela (who is our most experienced Canadian member)

 

[Shannon R]

Hi and welcome

Are you Canadian? Please add your country and province to your details, so we can tailor any advice to what is relevant where you live straight away. We have members from all over the world. You can make your location appear underneath your username in every post you make by clicking on your username on the top bar, then going to personal details and scrolling down to location. Thank you!

The smell very much points to an infection. Is he getting an antibiotic for that? Septrin/bactrim is usually the antibiotic that is best for urinary tract issues. Please continue with the metacam.

Bladder flushes need to be done very, very gently and carefully to prevent any fluid backing up into the kidneys.

I am tagging in our medically most experienced members for you although you may need to wait until tomorrow because of the time difference, as most are UK based.
@helen105281 @Jaycey @furryfriends (TEAS) @Freela (who is our most experienced Canadian member)

Thank you for the reply and the information on how to add location, as you can tell I am new to this. He was on antibiotics for a week post procedure but then we stopped it because we were worried his squealing and discomfort may be caused by the antibiotics. He also seems to let out gas and his poos are a bit hard. The gas may be because he is straining to pee though? My vet seems to think it is more of a urinary cause still. Super nervous about getting another catheterization but my gut feeling it is another stone. Perhaps the smell could be from stagnant urine sitting in the bladder. My first thought when I smelled the urine was infection too though. As I said I tried phone consultations with vets in Nova Scotia but they have not been helpful

 

[Shannon R]

There is also currently blood in the urine

 

[Shannon R]

Hi and welcome

Are you Canadian? Please add your country and province to your details, so we can tailor any advice to what is relevant where you live straight away. We have members from all over the world. You can make your location appear underneath your username in every post you make by clicking on your username on the top bar, then going to personal details and scrolling down to location. Thank you!

The smell and frequent urination very much points to an infection indeed.
Septrin/bactrim (sulfamethoxazole and trimethoprim) is usually the antibiotic that is working best for urinary tract issues, but it needs to be given for longer to be most effective. There are other, even stronger antibiotics that can be given to guinea pigs. Your vet may want to have the bacteria cultured to find the correct antibiotic; but she needs to make sure that any antibiotic is safe to use with guinea pigs.
Guinea Lynx :: Antibiotics
Guinea Lynx :: Dangerous Medications

Please continue with the metacam.

Bladder flushes need to be done very, very gently and carefully to prevent any fluid backing up into the kidneys. Baytril is often not strong enough to cut through bladder problems. What dosage/weight is your boy on?

I am tagging in our medically most experienced members for you although you may need to wait until tomorrow because of the time difference, as most are UK based.
@helen105281 @Jaycey @furryfriends (TEAS) @Freela (who is our most experienced Canadian member)

He was on 0.1ml of Baytril 2x daily for one week post procedure(which was April 27th) and 0.1ml 2x daily of meloxicam, and still is on that

 

[Freela]

Poor guy... I'm Canadian but from Ontario, unfortunately I don't know any vets in New Brunswick. I will go through the thread to catch up on the situation, though!

 

[Freela]

Awww, poor little man. I would wonder if the vet would consider switching the antibiotic and running the culture, whatever else you do. It may be that the bacteria is not susceptible to Baytril. I might try that before doing another flush, simply because it's lower-risk that another flush, and if it works it may make the second bladder flush unnecessary.

 

[DM030819]

I've not got any experience with bladder flushes but I do know about bladder stones.

Stones and sludge are very sharp and spiky when looked at under a microscope so they can be pretty painful and scrape when they come out so I would recommend asking your vet to increase the dose of Metacam. My boar was in so much pain he chewed everything in his cage and the vet had to prescribe Tramadol for him.

I would also recommend asking to swap to Bactrim/Septrin as Wiebke suggests as there definitely could be an infection involved.

Also a cystitis supplement such as Cystease (which contains Glucosamine) can sometimes help. It helps calm and line the bladder and urinary tract. It doesn't cure anything but it's addition can make things less irritating/painful.

Now to the problem itself. I would opt for another xray first as it's not an invasive (and can be done consciously if the vet is experienced with it). In my experience a stone or sludge may not appear in one xray and in a couple of months there is one. So it's always best to rule it out. And that might be the case Spike, especially as there were no stones in his xray and then two came out with a flush.

If he does have a stone the bladder flush might not help. Unfortunately with boars their "pipework" is very restrictive on what size will fit so the last thing we want is a stone to be forced into a place where the vet can't get it.

I hope your boy is okay @Shannon R . If I think if anything else I'll pop back on to post.

 

[Wiebke]

He was on 0.1ml of Baytril 2x daily for one week post procedure(which was April 27th) and 0.1ml 2x daily of meloxicam, and still is on that

The normal baytril dosage for guinea pigs of around 1 kg with bladder problems is 0.4 ml twice daily. Your vet has grossly underdosed, as I suspected. It is a common mistake that any vets not familiar with guinea pigs make; they scale down from a cat dosage and then err on the cautious side. Guinea pigs have a much faster metabolism, so you have to double, not halve a comparable dosage. Like cats, guinea pigs have a highly alkaline urine, which means that they are naturally prone to urinary tract issues. Yours may simply have a urinary tract infection (UTI), but it has so far been undertreated and has therefore not made any impact. Urinary tract problems also take much longer than just one week to clear. Baytril takes about 3 weeks to get on top of UTI and a course of bactrim/septrin about 4 weeks or even longer to make sure that it is really gone. This because of the alkaline environment, which promotes the growth of bacteria.

If your vet would be prepared to switch to either a much higher dosage of baytril, or even better, bactrim, that may halp you get on top of your infection. You may have to sign a disclaimer if you ask for medication that is not licensed for guinea pigs. Unfortunately baytril is still the only officially licensed antibiotic although bactrim (US)/septrin(UK) has been used safely for years, and is now available as unflavoured vet use antibiotic called sulfatrim in the UK.

Because your piggy's bladder is rather beleaguered, you may want to consider supporting the bladder walls with glucosamine. They are naturally coated with it. Piggy savvy vets use a glucosamine based cat food supplement called cystease (cystophan etc.); it is classed as food supplement, and not as medication. Cats are the other pet species prone to urinary tract problems. You can also give a vegetarian version of glucosamine from a pharmacy or health shop instead. It can contribute towards alleviating some of the discomfort.

 

[Shannon R]

I've not got any experience with bladder flushes but I do know about bladder stones.

Stones and sludge are very sharp and spiky when looked at under a microscope so they can be pretty painful and scrape when they come out so I would recommend asking your vet to increase the dose of Metacam. My boar was in so much pain he chewed everything in his cage and the vet had to prescribe Tramadol for him.

I would also recommend asking to swap to Bactrim/Septrin as Wiebke suggests as there definitely could be an infection involved.

Also a cystitis supplement such as Cystease (which contains Glucosamine) can sometimes help. It helps calm and line the bladder and urinary tract. It doesn't cure anything but it's addition can make things less irritating/painful.

Now to the problem itself. I would opt for another xray first as it's not an invasive (and can be done consciously if the vet is experienced with it). In my experience a stone or sludge may not appear in one xray and in a couple of months there is one. So it's always best to rule it out. And that might be the case Spike, especially as there were no stones in his xray and then two came out with a flush.

If he does have a stone the bladder flush might not help. Unfortunately with boars their "pipework" is very restrictive on what size will fit so the last thing we want is a stone to be forced into a place where the vet can't get it.

I hope your boy is okay @Shannon R . If I think if anything else I'll pop back on to post.

Thank you for your suggestions. Much appreciated. I forgot to mention we went back in for an x-ray and to palpate his bladder to make sure he wasn't blocked. This was on Friday last week. The x-ray showed nothing and his bladder was small. He ha been squealing all night in pain I wonder if that makes if more likely to be another stone then an infection. Not sure I will ask for Bactrim/Septrin this time

 

[Shannon R]

The normal baytril dosage for guinea pigs of around 1 kg with bladder problems is 0.4 ml twice daily. Your vet has grossly underdosed, as I suspected. It is a common mistake that any vets not familiar with guinea pigs make; they scale down from a cat dosage and then err on the cautious side. Guinea pigs have a much faster metabolism, so you have to double, not halve a comparable dosage. Like cats, guinea pigs have a highly alkaline urine, which means that they are naturally prone to urinary tract issues. Yours may simply have a urinary tract infection (UTI), but it has so far been undertreated and has therefore not made any impact. Urinary tract problems also take much longer than just one week to clear. Baytril takes about 3 weeks to get on top of UTI and a course of bactrim/septrin about 4 weeks or even longer to make sure that it is really gone. This because of the alkaline environment, which promotes the growth of bacteria.

If your vet would be prepared to switch to either a much higher dosage of baytril, or even better, bactrim, that may halp you get on top of your infection. You may have to sign a disclaimer if you ask for medication that is not licensed for guinea pigs. Unfortunately baytril is still the only officially licensed antibiotic although bactrim (US)/septrin(UK) has been used safely for years, and is now available as a small exotics antibiotic called sulfatrim in the UK.

Because your piggy's bladder is rather beleaguered, you may want to consider supporting the bladder walls with glucosamine. They are naturally coated with it. Piggy savvy vets use a glucosamine based cat food supplement called cystease (cystophan etc.); it is classed as food supplement, and not as medication. Cats are the other pet species prone to urinary tract problems. You can also give a vegetarian version of glucosamine from a pharmacy or health shop. It can contribute towards alleviating some of the discomfort.

Thank you. I will keep all these things in mind and mention them to my vet today, especially perhaps switching to Bactrim. Poor guy was up all night squealing We are going in to the vet today!

 

[Shannon R]

I've not got any experience with bladder flushes but I do know about bladder stones.

Stones and sludge are very sharp and spiky when looked at under a microscope so they can be pretty painful and scrape when they come out so I would recommend asking your vet to increase the dose of Metacam. My boar was in so much pain he chewed everything in his cage and the vet had to prescribe Tramadol for him.

I would also recommend asking to swap to Bactrim/Septrin as Wiebke suggests as there definitely could be an infection involved.

Also a cystitis supplement such as Cystease (which contains Glucosamine) can sometimes help. It helps calm and line the bladder and urinary tract. It doesn't cure anything but it's addition can make things less irritating/painful.

Now to the problem itself. I would opt for another xray first as it's not an invasive (and can be done consciously if the vet is experienced with it). In my experience a stone or sludge may not appear in one xray and in a couple of months there is one. So it's always best to rule it out. And that might be the case Spike, especially as there were no stones in his xray and then two came out with a flush.

If he does have a stone the bladder flush might not help. Unfortunately with boars their "pipework" is very restrictive on what size will fit so the last thing we want is a stone to be forced into a place where the vet can't get it.

I hope your boy is okay @Shannon R . If I think if anything else I'll pop back on to post.

Thanks for the advice. I was able to get in touch with an exotic vet in Quebec, Canada. He said his Metacam dose was way too low for acute pain and suggested an increase. I am also going to ask him about the antibiotics. When Spike didnt get better a week after the first flush..we went back in for an x-ray and to palpate his bladder to make sure he wasn't blocked. x-Ray showed nothing and his bladder was small. So now I am at the point of having to make a decision of doing a culture and waiting 4-5 days,with Spike being in a lot of pain and if its not an infection, regretting not doing a flush...Or doing another flush, knowing the benefits may outweigh the risks if its another small stone. Stressful times

 

[Shannon R]

Poor guy... I'm Canadian but from Ontario, unfortunately I don't know any vets in New Brunswick. I will go through the thread to catch up on the situation, though!

Thanks for the response. I actually got in touch with an exotic vet in Quebec last night. I'm hoping my vet can reach out to him today before going ahead with anything. The one thing he did mention for sure was that his metacam should be increased!

 

[Wiebke]

Thank you for your suggestions. Much appreciated. I forgot to mention we went back in for an x-ray and to palpate his bladder to make sure he wasn't blocked. This was on Friday last week. The x-ray showed nothing and his bladder was small. He ha been squealing all night in pain I wonder if that makes if more likely to be another stone then an infection. Not sure I will ask for Bactrim/Septrin this time

If the x-ray has come clear, then there is no worries about stones; they do not form that quickly. Sludge/cystals in the bladder would also show up.

Thank you. I will keep all these things in mind and mention them to my vet today, especially perhaps switching to Bactrim. Poor guy was up all night squealing We are going in to the vet today!

Please make sure that your vet is giving a high enough dosage! The symptoms you are reporting are consistent with a bad urine infection (UTI). As he has had a scan, you do not worry about stones or sludge.

Please weigh him daily at the same time to monitor his food intake. If necessary, start topping him up with syrine feed. Offer him extra water, as much as he will take willingly - about 0.3-0.5 ml at a time. That is about a mouthful to make sure that it doesn't go down the wrong way.
Mild diuretic veg like dandelion, cucumber and lettuce can help with flushing the bladder, but you have to be careful to nor give too much, or he'll get diarrhea.

With the higher dosage of antibiotics, you may want to give a pinch of probiotics (available from a pet shop) to help bolster the guts. the US recommendation is to give them 1-2 hours before the antibiotic, the UK recommendation is for 1-2 hours afterwards. This again is just a supportive measure and not a medication.

If your vet wants to work out the dosage of bactrim, this Guinea Lynx link gives the dosage calculator for guinea pigs. This has been set up to help vets not familiar with guinea pigs. You may want to go to the link and copy the address for your vet to look up if she wishes to.
Both our forum and the Guinea Lynx website stress the importance of vet care and do not support home care on spec; this for your vet. We only recommend treatments/medications for a vet to consider that we know have been safely used on guinea pigs by experienced guinea pig vets. Guinea Lynx :: Antibiotics

 

[Shannon R]

If the x-ray has come clear, then there is no worries about stones; they do not form that quickly. Sludge/cystals in the bladder would also show up.




Please make sure that your vet is giving a high enough dosage! The symptoms you are reporting are consistent with a bad urine infection (UTI). As he has had a scan, you do not worry about stones or sludge.

Please weigh him daily at the same time to monitor his food intake. If necessary, start topping him up with syrine feed. Offer him extra water, as much as he will take willingly - about 0.3-0.5 ml at a time. That is about a mouthful to make sure that it doesn't go down the wrong way.
Mild diuretic veg like dandelion, cucumber and lettuce can help with flushing the bladder, but you have to be careful to nor give too much, or he'll get diarrhea.

With the higher dosage of antibiotics, you may want to give a pinch of probiotics (available from a pet shop) to help bolster the guts. the US recommendation is to give them 1-2 hours before the antibiotic, the UK recommendation is for 1-2 hours afterwards. This again is just a supportive measure and not a medication.

If your vet wants to work out the dosage of bactrim, this Guinea Lynx link gives the dosage calculator for guinea pigs. This has been set up to help vets not familiar with guinea pigs. Both our forum and the Guinea Lynx website stress the importance of vet care and do not support home care on spec; this for your vet. We only recommend treatments/medications for a vet to consider that we know have been safely used on guinea pigs by experienced guinea pig vets. Guinea Lynx :: Antibiotics

Thanks! I called a few pet stores around in the past and they do not have any Probiotics. They were supposed to call around and get back to me on where I could find it. As far as the x-ray, that is what I thought, no stone on x-ray=no stone. But we had multiple x-rays before his bladder flush ~two weeks ago and then we decided to go ahead with the flush and two small stones ended up coming out, she thinks one was lodged in the urethra as it was reddish. So this is why I am torn on what to do. Below are the two little stones.

 

[Wiebke]

Thanks! I called a few pet stores around in the past and they do not have any Probiotics. They were supposed to call around and get back to me on where I could find it. As far as the x-ray, that is what I thought, no stone on x-ray=no stone. But we had multiple x-rays before his bladder flush ~two weeks ago and then we decided to go ahead with the flush and two small stones ended up coming out, she thinks one was lodged in the urethra as it was reddish. So this is why I am torn on what to do. Below are the two little stones.

View attachment 63269

View attachment 63270

The irritation from the stones has likely caused the cystitis/UTI. The symptoms and treatment for both are the same.

In order to minimise the risk of a return of stones, it would be good if you made some dietary changes:
- filter your water, even if you live in a soft water area; it still contains minerals. Filtering can really make a surprisingly large difference.
- either switch to low calcium/ideally timothy hay based pellets (about 10-20g per piggy per day), or if these are not available, reduce the amount you are feeding to max. 10g per piggy per day (about 1 tablespoon full).
- switch to a diet like we recommend in our sample diet (minus the lettuce); it is nutritionally as balanced as possible for the long term. Stay off too much high calcium, high sugar/starch veg (like root veg or sweet corn) etc.
Recommendations For A Balanced General Guinea Pig Diet

These measures should help to minimise the risk of more stones and also remove trigger foods that can make an infection worse.

You should be able to source probiotics and cystease either on ebay or amazon or on vet product sites. Additional vitamin C (oxbow sell tablets) can help to boost the immune system if you give it for 2-3 weeks.

PS: If the discomfort is very strong, you can also double the metacam safely.

 

[Shannon R]

The irritation from the stones has likely caused the cystitis/UTI. The symptoms and treatment for both are the same.

In order to minimise the risk of a return of stones, it would be good if you made some dietary changes:
- filter your water, even if you live in a soft water area; it still contains minerals. Filtering can really make a surprisingly large difference.
- either switch to low calcium/ideally timothy hay based pellets (about 10-20g per piggy per day), or if these are not available, reduce the amount you are feeding to max. 10g per piggy per day (about 1 tablespoon full).
- switch to a diet like we recommend in our sample diet (minus the lettuce); it is nutritionally as balanced as possible for the long term. Stay off too much high calcium, high sugar/starch veg (like root veg or sweet corn) etc.
Recommendations For A Balanced General Guinea Pig Diet

These measures should help to minimise the risk of more stones and also remove trigger foods that can make an infection worse.


You should be able to source probiotics and cystease either on ebay or amazon or on vet product sites. Additional vitamin C (oxbow sell tablets) can help to boost the immune system if you give it for 2-3 weeks.

PS: If the discomfort is very strong, you can also double the metacam safely.

Thanks again! I just dropped him off at the vet and we decided to start with urinalysis, cultures and blood work to check kidney function(so we can safely increase his metacam dose). She is going to clean his private area to make sure there isn't any pus/dirt. I asked about Bactrim and she is going to put him on that while awaiting for the cultures, she is going to call the vet is Quebec to check doses. Hopefully this all does the trick. If not, we will look at another bladder flush in the chance their may be another small stone. I will try to find the probiotics and supplement online as well. I have been giving him the Vitamin C tablets!

 

[Wiebke]

Thanks again! I just dropped him off at the vet and we decided to start with urinalysis, cultures and blood work to check kidney function(so we can safely increase his metacam dose). She is going to clean his private area to make sure there isn't any pus/dirt. I asked about Bactrim and she is going to put him on that while awaiting for the cultures, she is going to call the vet is Quebec to check doses. Hopefully this all does the trick. If not, we will look at another bladder flush in the chance their may be another small stone. I will try to find the probiotics and supplement online as well. I have been giving him the Vitamin C tablets!

Long term experiences with metacam have actually found that guinea pigs cope very well with it and that the risk of potential kidney damage in guinea pigs is actually a lot smaller than previously assumed.

But I am glad that you have got bactrim and hopefully on a high enough dosage to do your piggy some good. it is always tricky for any vet who is not experienced and does not have any piggy savvy vet to contact for information and support.

I would strongly recommend to look into the dietary tips for longer term care. Please ask your vet to be careful with another bladder flush and rather think twice about doing one so soon after the other.

 

[Cocoteemin]

Amazon.ca sells a probiotic called Bene-Bac Plus, it is a gel that comes in little tubes. I use it for my guinea pigs. Pet Valu also carries it as well, if your local store doesn't have it in stock, you can print the info for it off their website and some stores will special order it in for you.

 

[Shannon R]

Long term experiences with metacam have actually found that guinea pigs cope very well with it and that the risk of potential kidney damage in guinea pigs is actually a lot smaller than previously assumed.

But I am glad that you have got bactrim and hopefully on a high enough dosage to do your piggy some good. it is always tricky for any vet who is not experienced and does not have any piggy savvy vet to contact for information and support.

I would strongly recommend to look into the dietary tips for longer term care. Please ask your vet to be careful with another bladder flush and rather think twice about doing one so soon after the other.

I already follow the advice for the dietary tips. They get very little pellets and now I am considering cutting them out completely. I buy bottled water for them as we are on city water. Is this appropriate?