Specialist Infection of bladderwall

[nsthomann]

My girl Adele (3 1/2 years old) shows blood in her urine and sometimes squeaks when passing urine together with droppings. Exotics specialist put her on Metacam (0.3 cc once daily; she weighs 1 kg; and on Sulfatrim, 0.625 cc twice daily). Ultrasound showed thickening of the bladder wall and a finger-like extension of the bladder wall tissue into the bladder cavity. Next step should be urine sample taken under sedation as well as a biopsy. I am not sure if I want to have my baby girl go through this as she has issues with her molars, too, and needs trimmings (she lost her mom and her 2 sisters due to issues with molars and jawbone/muscle ..- seems to be genetic).
Is there anyone out there who is experiencing similar issues currently? I am supposed to wean her off the Metacam now after 2 weeks but Ido have the feeling that she squeaks more now .... What dosages are you using? Any antibiotics? Any other meds such as Cystease?
Vet didn't rule out that it could be cancer - but I don't want a biopsy .... malignant cells could spread out then ... If bladder wall infection, the bacteria would sit in the wall ... does this mean a biopsy plus culture of biopsy is indeed necessary?

 

[Wiebke]

Please do not wean your girl off the metacam; it is not just a much needed painkiller, but also an anti-inflammatory that works on the thickened bladder wall as much any antibiotic works on antibiotics. Metacam is important to give with any cystitis.

The sulfatrim dosage is high considering it is double the strength of the old pediatric septrin; the metacam (I assume it is dog metacam?) is perfectly OK to give.
Glucosamine-based cystease to support the beleaguered natural bladder wall coating is always recommended. It is not a medication, but classed as a cat food supplement, who are the other pet species prone to bladder problems.

The thickened bladder wall from a cystititis, whether it is a bacterial or a sterile (i.e. non-bacterial one) is not at all uncommon. We see plenty of piggies like that.
The extension of the tissue into the bladder is however unusual and would need investigation.

I am linking in some other members with medical experience for you.
@Jaycey @helen105281 @furryfriends (TEAS) @Abi_nurse

 

[nsthomann]

Thank you for your response. I decided to continue the Metacam but at 0.2 cc once daily (dog metacam at 1.5 mg/ml). Bactrim (TMP) was first at 0.4 cc but then was increased to standard dose of 0.625 cc/kg pig/12 hrs. Thought was that under-dosage might have caused reoccurrence of blood, i.e. did not stop the spotting and the pink urine (which seems to come through a blood drop that then gets mixed in with the urine.).
No worries about kidney failure due to Metacam?
What would be the optimal dose for the cystease?

 

[nsthomann]

My girl Adele (3 1/2 years old) shows blood in her urine and sometimes squeaks when passing urine together with droppings. Exotics specialist put her on Metacam (0.3 cc once daily; she weighs 1 kg; and on Sulfatrim, 0.625 cc twice daily). Ultrasound showed thickening of the bladder wall and a finger-like extension of the bladder wall tissue into the bladder cavity. Next step should be urine sample taken under sedation as well as a biopsy. I am not sure if I want to have my baby girl go through this as she has issues with her molars, too, and needs trimmings (she lost her mom and her 2 sisters due to issues with molars and jawbone/muscle ..- seems to be genetic).
Is there anyone out there who is experiencing similar issues currently? I am supposed to wean her off the Metacam now after 2 weeks but Ido have the feeling that she squeaks more now .... What dosages are you using? Any antibiotics? Any other meds such as Cystease?
Vet didn't rule out that it could be cancer - but I don't want a biopsy .... malignant cells could spread out then ... If bladder wall infection, the bacteria would sit in the wall ... does this mean a biopsy plus culture of biopsy is indeed necessary?

 

[Wiebke]

Thank you for your response. I decided to continue the Metacam but at 0.2 cc once daily (dog metacam at 1.5 mg/ml). Bactrim (TMP) was first at 0.4 cc but then was increased to standard dose of 0.625 cc/kg pig/12 hrs. Thought was that under-dosage might have caused reoccurrence of blood, i.e. did not stop the spotting and the pink urine (which seems to come through a blood drop that then gets mixed in with the urine.).
No worries about kidney failure due to Metacam?
What would be the optimal dose for the cystease?

Unlike other species, guinea pigs tolerate metacam really well. But because of their high metabolism, they require a higher dosage even in the longer term. Please DO NOT underdose it and if possible give it every 12 hours; it is metabolised in about 10 hours.
If you are dealing with a sterile interstitial cystitis (i.e. a recurring cystitis which does not respond to antibiotics, often referred to as IC and increasingly common in guinea pigs), metacam is key to any treatment. If you ever had a bladder infection, you will know just how painful it is!
Highly porphyrine coloured urine, which may or may not contain blood, is typical for the onset of an acute cystitis flare. Clear blood can however test very high on blood content. Many people, even vets, are not quite aware that the urine colour and blood content are not the same. In your case, there is however the possibility that you are dealing with real bleeding because of the growth in the bladder and the high likelihood that it is being very irritated by the flow of stuff passing through the bladder all the time.

Cystease is 1 capsule per day, mixed with 2 ml of water, shaken and then syringed.

 

[nsthomann]

Now I finally realized - you are Wiebke from Wiebke's tribe! :-) I follow your posts on Facebook !
I know that there are 2 opinions regarding the use and dosage of Metacam .... What would you recommend as a standard dose for a 1 kg pig? She was on 0.3 cc twice daily after molar trimming, then once daily on 0.3 cc. Then we noticed the blood ... and Sulfatrim/Bactrim has been added (she is in the second week of her treatment). I am now giving only 0.2 cc Metacam once daily - she is eating and rests very relaxed - it doesn't look as if she is in pain. Bactrim has an inflammatory effect as well, maybe that's why.
Would YOU recommend to agree to the biopsy and urine extraction from bladder for further analysis - under sedation? I am always afraid of sedation and anesthesia because she might have to undergo frequent trimmings of her molars ... and our last piggy (Adele's mom) we just lost because she didn't recover well from the anesthesia. I am also worried if cancer it might spread through the biopsy.
Thanks so much for all your advice and suggestions!

 

[DM030819]

@nsthomann I currently have a 1kg pig who is on 0.25ml of dog Metacam twice a day for arthritis. I've used it long term a few times which hasn't resulted in kidney damage.

Why do they need to extract urine from the bladder? Can they not do a regular urine test instead?

We can't really recommend to do the biopsy or not as each situation is very different. It all depends on the competency of the vet and their ability to do it, the strength and wellbeing of the pig, the ability and time of the owner to provide aftercare and the cost.

You could try using Cystease (I use Cystassist) first to see if it helps and if not then consider the surgery.

 

[nsthomann]

@nsthomann I currently have a 1kg pig who is on 0.25ml of dog Metacam twice a day for arthritis. I've used it long term a few times which hasn't resulted in kidney damage.

Why do they need to extract urine from the bladder? Can they not do a regular urine test instead?

We can't really recommend to do the biopsy or not as each situation is very different. It all depends on the competency of the vet and their ability to do it, the strength and wellbeing of the pig, the ability and time of the owner to provide aftercare and the cost.

You could try using Cystease (I use Cystassist) first to see if it helps and if not then consider the surgery.

what do you mean by 'regular urine test'? Vet wants to avoid contamination with bacteria that sits in urethra etc. - that's why he prefers to extract directly from the bladder using a needle (under sedation..). :-(

 

[DM030819]

@nsthomann Where the vet makes the pig pee by gently pressing on their bladder. I'm surprised that your vet hasn't tried that first.

It might highlight something so a more invasive test wouldn't be needed.

 

[Merab]

Can’t advise but wanted to offer support

 

[Abi_nurse]

Hello there,
Sorry your little pig isn't well. Please call your vet and either discuss over the phone or go in for a consultation. Unfortunately without any further diagnostics (the urine sample, biopsy etc) then you cannot know what you are fighting 100% so the treatment she is on may or may not be of use. I completely understand you not wanting to do this, some people do not and there is always a risk of course. But you will also need to know that you may never know what the issue is and it may or may not resolve on the current medications. I also agree the metacam should ideally continue, she is already on a low dose it seems so don't drop it any further. Have a chat with your vet and come up with a treatment plan for her and see what the urine test says. I have seen thickened bladders and like you've said can be cystitis, can also be a stone, cancer or other abnormality.

Abi

 

[Abi_nurse]

what do you mean by 'regular urine test'? Vet wants to avoid contamination with bacteria that sits in urethra etc. - that's why he prefers to extract directly from the bladder using a needle (under sedation..). :-(

Nsthomann is correct. Just to clarify, we need to take urine directly from the bladder to get a sterile sample. (Getting a sample from the floor isn't). This way you can culture the urine for bacteria so we know exactly what we are fighting in the bladder. Culturing a sample from the floor etc is likely to have bacteria from the environment and from the outer parts of the piggies urinary tract so would be useless in this sense.

Hope this makes sense.
Abi