Recurring bladder stones... when is euthanasia ok?

[annachristina_piggies]

Tommy, a boar aged 2, has had three bladder stones removed. The first in July 2019, successful surgery and recovery. He then had another removed in February 2020 and very quickly developed another one, which was removed recently in March. The vet did say that if he is developing the stones so quickly again it is not fair to keep putting him through surgery if his pain free time inbetween is short. Although he again recovered quickly from the surgery, 6 weeks later he is now showing signs of another bladder stone. He is the most loving, energetic pig and I am so not ready to lose him after only 2 years, but at £700 per surgery and the liklihood of another stone growing a month later, I am really struggling with what decision to make. I would really appreciate everyone's thoughts.

 

[DMS260820]

I agree with the vet, but and a big but... What diet are you feeding In between these surgeries? Are you filtering water if you have hard water? Limiting pellets?

 

[Wiebke]

Tommy, a boar aged 2, has had three bladder stones removed. The first in July 2019, successful surgery and recovery. He then had another removed in February 2020 and very quickly developed another one, which was removed recently in March. The vet did say that if he is developing the stones so quickly again it is not fair to keep putting him through surgery if his pain free time inbetween is short. Although he again recovered quickly from the surgery, 6 weeks later he is now showing signs of another bladder stone. He is the most loving, energetic pig and I am so not ready to lose him after only 2 years, but at £700 per surgery and the liklihood of another stone growing a month later, I am really struggling with what decision to make. I would really appreciate everyone's thoughts.

BIG HUGS
I am very sorrry for your dilemma.

Dietary changes may take a few weeks to come through but have you made any (filtering water or using low calcium bottled water, feeding low calcium pellets at just 1 tablespoon per day or less (these two measures are the most important as in the UK the highest source of calcium is water and even low calcium pellets contain more than even the highest calcium veg)?
Long Term Balanced General And Special Needs Guinea Pig Diets
(Includes dietary tips for guinea pigs with long term bladder stone and urinary tract problems.)

Please make sure that if your boy is not a good drinker that you feed more watery veg to ensure some stronger urination in order to flush out the bladder.

There are in your case likely some more factors at play like a genetic disposition or issues with the complex calcium absorption process but these measures usually work in the longer term. I have only ever had one piggy with chronic issues that needed a bladder flush every 8 weeks at first until we could gradually extend the interval to about every 4-6 months. she lived for another 2 years (including an emergency spay when her womb went wrong) but she was admittedly my most expensive piggy to date!

I can't tell you what is right or wrong; there is a big grey area in which it is more of a matter how you balance the several factors in play out for your piggy and for yourself.
Financial considerations are a valid point, especially with ongoing support/continuing high cost medical care/operative treatment that is becoming a burden you cannot afford to let run on unchecked and that is also bound to take its toll on your guinea pig.
Hopefully this new guide that I have written can help you work your own way through the ethics of it all: A Practical and Sensitive Guide to Dying, Terminal Illness and Euthanasia in Guinea Pigs

 

[annachristina_piggies]

Thank you for your replies! Yes, for the past 4 months we have been filtering water, and significantly reduced high calcium veg. He only ever gets tomatoes, cucumber and peppers, occassionally carrot and celery. I am however learning today that it isn't just about the calcium levels but also about the Ca levels - something that I need to look into more to understand. Pellets are the lowest that I could fine in the UK (and most expensive it would seem haha!) - Science selective grainless guinea pig pellets. Tommy is also on two forms of preventative medication - a diuretic and potassium citrate. If there are some viable changes I could make to his lifestyle to reduce the chances of another forming so quickly again I would definitely be open to these, however I do feel like I have already made a lot of changes that haven't made a difference sadly.

 

[Eriathwen]

This is a decision I have been thinking about too lately, after a second stone scare with my Leonard about 5-6 weeks ago. He is 6 months since his cystotomy for the first stone and when he was xrayed and given an ultrasound this time around it showed his bladder is still quite inflamed and scarred from surgery, I would assume that there are only so many surgeries a bladder can actually take, which would vary pig to pig. I have reached the decision that we would try one last time should another stone form although he is already palliative due to other conditions, so I do not want the time he has left to be surgery after surgery. It's such a hard decision when they are otherwise perfectly fine and happy in between issues.

It's also really hard to know what to do for the best, diet wise, there has been some suggestion that vitamin C in large amounts creates urinary oxalates which can result in the formation of calcium oxalate stones...but of course, you can't stop giving vitamin C! Thats on top of all the calcium, phosphorus, vitamin D, magnesium and all the other minerals that help with the absorption of calcium..it's quite a headache.

Just remember there is no wrong decision, you've got to do what you've got to do, unfortunately sometimes no amount of money and love can fix them.

 

[annachristina_piggies]

I'm trying to look at the guinealynx chart and it's hard to know, are the the lowest Ca ratios the best to choose for bladder stone prone pigs?

 

[Eriathwen]

A guinea pigs diet ideally should have a Ca: P of 1.3:1 although up to 1.6:1 is also passable, that ensures that the calcium is utilised as best as possible...however, it is really difficult to accurately give a diet that is bang on considering you cant really work out the ratios in hay, water etc making all the working out of the veggie ratios a bit less accurate, which is why the Ca: P diets arent pushed as much as they used to be, rather, a diet with a good variety/good mix of nutrients is seen as more ideal, such as the sample diet in the link Wiebke provided.

 

[Wiebke]

Thank you for your replies! Yes, for the past 4 months we have been filtering water, and significantly reduced high calcium veg. He only ever gets tomatoes, cucumber and peppers, occassionally carrot and celery. I am however learning today that it isn't just about the calcium levels but also about the Ca levels - something that I need to look into more to understand. Pellets are the lowest that I could fine in the UK (and most expensive it would seem haha!) - Science selective grainless guinea pig pellets. Tommy is also on two forms of preventative medication - a diuretic and potassium citrate. If there are some viable changes I could make to his lifestyle to reduce the chances of another forming so quickly again I would definitely be open to these, however I do feel like I have already made a lot of changes that haven't made a difference sadly.

The problem with ca : ph diet recommendations is that they tend to completely blend out the calcium that comes in from the water, the pellets and the hay and only concentrate on the veg. With the notable exception of a single member none of our long term members who have tried had any success. I have given up after two more bladder stone ops in my own piggies and have moved onto a moderate calcium diet - and haven't had a bladder stone in over 7 years with a higher proportion of my piggies living to the upper end of the average life span.
The diet would be ideal if it wasn't so difficult to get the diet just right for where you are. As it is in effect a very high calcium diet, the result (if you get it just a bit wrong) are bladder stones very quickly! This is why we have removed a guide thread from our early years after too many complaints and negative experiences.

PS: Tomatoes and carrot are not food that should feature regularly (see the diet link in my last post). They are at the best more in the way of a very occasional treat in a very small quantity.
Ideally you concentrate on a green leafy diet with enough watery veg to help keep the bladder flushed regularly. If you have access to a garden, put your boy on fresh grass if you can get him used gradually to larger volumes in combination with hay. It is the food piggies have evolved on; what most people are unaware is that fresh grass is high in vitamin c and hay also contains it. Your piggy still needs unlimited hay as too much fresh food is not good, and you have to introduce grass slowly so you do not end up with diarrhea or bloat.

 

[annachristina_piggies]

Thanks everyone. Tommy (along with my other guinea pig Piglet, who has got ongoing UTI problems) are both at the vets this morning for xrays. My vet told me to strip out any leafy greens after a third stone formed in March (we were giving lettuce one a day) - looking at lower calcium veg it's really hard to be left with anything! They have access to Oxbow timothy Hay at all times and a small portion of science select grain free pellets. I have been researching options about a pellet free diet but I can't find enough information about how to ensure they get vitamins elsewhere in their diet.

 

[DMS260820]

Thanks everyone. Tommy (along with my other guinea pig Piglet, who has got ongoing UTI problems) are both at the vets this morning for xrays. My vet told me to strip out any leafy greens after a third stone formed in March (we were giving lettuce one a day) - looking at lower calcium veg it's really hard to be left with anything! They have access to Oxbow timothy Hay at all times and a small portion of science select grain free pellets. I have been researching options about a pellet free diet but I can't find enough information about how to ensure they get vitamins elsewhere in their diet.

I was just advised by my vet to keep giving picked grass, and keep wet veg going through. I'm using Bell peppers as the main part of veg. Green and red. Lots of people don't give a wet enough diet, guinr a pigs don't drink much, grass is nice and moist

 

[annachristina_piggies]

We live in a shared garden so the piggies don't get as much time there as I would like, I could try to cut some grass myself and bring it up to their cage inside though. They get cucumber every day to try and increase their water in take along with pepper (although they are not a fan of green peppers!)

 

[DMS260820]

We live in a shared garden so the piggies don't get as much time there as I would like, I could try to cut some grass myself and bring it up to their cage inside though. They get cucumber every day to try and increase their water in take along with pepper (although they are not a fan of green peppers!)

Yea I don't have, I don't have a garden so have to go out and pick grass

 

[Wiebke]

We live in a shared garden so the piggies don't get as much time there as I would like, I could try to cut some grass myself and bring it up to their cage inside though. They get cucumber every day to try and increase their water in take along with pepper (although they are not a fan of green peppers!)

Fresh grass is best (if you can rip it instead of cutting it, you can keep fermentation at bay) - but you need to introduce it carefully and make sure that it is dog pee free (fresh dog pee can kill) and doesn't come from a recently treated lawn or one that is being mowed with a petrol mower. If you start them off with too much, you end up with either diarrhea or bloat.
Feeding Grass And Preparing Your Piggies For Lawn Time

My piggies get a piece of cucumber and a piece of celery daily. They also have romaine/cos or gem lettuce whenever possible to help keep the bladder flushed. Fresh herbs do have calcium but they are also high in important minerals, vitamins etc. so mine get a little of that because herbs pack a lot in a small amount and the overall balance of nutrition should always be retained.
I DO feed a modicum of calcium rich leaves including a little kale every now and then when greens are not available - not daily (never on a day I feed fresh herbs) and the emphasis is on little for either - but as stated before, a totally calcium-free diet is as detrimental in the longer term.

Keep in mind that a spoonful of pellets still has quite a bit more calcium than any kale, which is the highest calcium veg.
It is the water and the pellets where most of the calcium come from, not a veg diet! Please keep the diet as green as you can.

 

[annachristina_piggies]

Fresh grass is best (if you can rip it instead of cutting it, you can keep fermentation at bay) - but you need to introduce it carefully and make sure that it is dog pee free (fresh dog pee can kill) and doesn't come from a recently treated lawn or one that is being mowed with a petrol mower. If you start them off with too much, you end up with either diarrhea or bloat.
Feeding Grass And Preparing Your Piggies For Lawn Time

My piggies get a piece of cucumber and a piece of celery daily. They also have romaine/cos or gem lettuce whenever possible to help keep the bladder flushed. Fresh herbs do have calcium but they are also high in important minerals, vitamins etc. so mine get a little of that because herbs pack a lot in a small amount and the overall balance of nutrition should always be retained.
I DO feed a modicum of calcium rich leaves including a little kale every now and then when greens are not available - not daily (never on a day I feed fresh herbs) and the emphasis is on little for either - but as stated before, a totally calcium-free diet is as detrimental in the longer term.

Keep in mind that a spoonful of pellets still has quite a bit more calcium than any kale, which is the highest calcium veg.
It is the water and the pellets where most of the calcium come from, not a veg diet! Please keep the diet as green as you can.

Thank you so much Wiebke. Tommy has another stone unfortunately, the vet says he is happy to go ahead in surgery but in 1-2 weeks to give the bladder maximum amount of time between the last surgery and this one. The stone is currently quite small so we will continue with pain management until the pain increases in a week or so and then go ahead with surgery. I will follow your recommended diet as strictly as I can, but I think if another stone develops after this one is removed we will have to call it a day, both for Tommy's long term prognosis and my finances.

 

[Wiebke]

Thank you so much Wiebke. Tommy has another stone unfortunately, the vet says he is happy to go ahead in surgery but in 1-2 weeks to give the bladder maximum amount of time between the last surgery and this one. The stone is currently quite small so we will continue with pain management until the pain increases in a week or so and then go ahead with surgery. I will follow your recommended diet as strictly as I can, but I think if another stone develops after this one is removed we will have to call it a day, both for Tommy's long term prognosis and my finances.

I am very sorry for the bad news. Unfortunately it is a bit of a race against time in your case as to how quickly the body can react to the dietary changes...

Please also continue with the glucosamine; it builds up and goes quite a long way towards protecting the bladder and making it less painful as the stone is inevitably banging against the wall or the opening with every pee.

 

[annachristina_piggies]

I am very sorry for the bad news. Unfortunately it is a bit of a race against time in your case as to how quickly the body can react to the dietary changes...

Please also continue with the glucosamine; it builds up and goes quite a long way towards protecting the bladder and making it less painful as the stone is inevitably banging against the wall or the opening with every pee.

What's the glucosamine?

 

[Wiebke]

What's the glucosamine?

Something like cystease. I have mentioned it to you before. We recommend Feliway cystease capsules for cats, which are widely available online.
Mix the content of one capsule with 2 ml of water in a small medicine bottle, wait until the powder has been absorbed in the water, shake well again and either syringe 1 ml of the mix every 12 hours or 2 ml every 24 hours.

 

[annachristina_piggies]

Something like cystease. I have mentioned it to you before. We recommend Feliway cystease capsules for cats, which are widely available online.
Mix the content of one capsule with 2 ml of water in a small medicine bottle, wait until the powder has been absorbed in the water, shake well again and either syringe 1 ml of the mix every 12 hours or 2 ml every 24 hours.

Got it from the vet today! Both Tommy and Piglet will be on this now. In regards to the recommend balanced diet you are referring to, I am going to follow this now (minus the lettuce for both). Neither of my pigs will eat runner beans at all - is there anything similar I can substitute?

 

[DMS260820]

Got it from the vet today! Both Tommy and Piglet will be on this now. In regards to the recommend balanced diet you are referring to, I am going to follow this now (minus the lettuce for both). Neither of my pigs will eat runner beans at all - is there anything similar I can substitute?

If you keep using cystease for a long time, try vet UK website, I just ordered 90 cystease capsules for about £20. That's 3 packets

 

[annachristina_piggies]

If you keep using cystease for a long time, try vet UK website, I just ordered 90 cystease capsules for about £20. That's 3 packets

Thank you, I will do in the future. Luckily today it was 'prescribed' for Piglet so my insurance will cover it for him.

 

[DMS260820]

Or you can get 300 for about £48. But that's really long term

 

[Wiebke]

Got it from the vet today! Both Tommy and Piglet will be on this now. In regards to the recommend balanced diet you are referring to, I am going to follow this now (minus the lettuce for both). Neither of my pigs will eat runner beans at all - is there anything similar I can substitute?

Runner beans are just featured as an example for the piece in your diet that you can vary to your own liking or your piggies' personal preferences.
Bladder stone piggies can eat lettuce; it is more guinea pigs with sterile (i.e. antibiotic resistent) cystitis that can have a negative response to it.

 

[annachristina_piggies]

Runner beans are just featured as an example for the piece in your diet that you can vary to your own liking or your piggies' personal preferences.
Bladder stone piggies can eat lettuce; it is more guinea pigs with sterile (i.e. antibiotic resistent) cystitis that can have a negative response to it.

Hmm well piglet seems to have cystitis so we will avoid lettuce!

 

[Wiebke]

Hmm well piglet seems to have cystitis so we will avoid lettuce!

He has most likely bacterial cystitis, which can be cured by an antibiotic. But if you are not happy about lettuce, then leave it out.
Sterile interstitial cystitis is a longer term condition that is not related to bladder stones or bladder damage from stones.

 

[annachristina_piggies]

He has most likely bacterial cystitis, which can be cured by an antibiotic. But if you are not happy about lettuce, then leave it out.
Sterile interstitial cystitis is a longer term condition that is not related to bladder stones or bladder damage from stones.

Tommy is my piggy with a bladder stone, piglet is my other pig who has been on two different antibiotics for a UTI for the last month which haven’t helped - after a negative X-ray today for piglet the vet presumes cystitis. Apologies for the confusion

 

[Wiebke]

Tommy is my piggy with a bladder stone, piglet is my other pig who has been on two different antibiotics for a UTI for the last month which haven’t helped - after a negative X-ray today for piglet the vet presumes cystitis. Apologies for the confusion

Thank you! I did get a bit confused since I jump between lots and lots of different threads all the time. After a few ten thousand threads and a decade down the line just on this forum, I simply can't keep them all in my head anymore...

If a months' worth of antibiotics have not cleared up a UTI, then you are unfortunately most likely dealing with a sterile IC.

I have had it carried into mine over a year ago; treatment is with mainly glucosamine and metacam - the latter especially for any flare-ups. The good news is that sterile IC doesn't cause bladder stones in itself and doesn't shorten the life expectancy but it is not something that goes away quickly. Mine thankfully don't have a problem with lettuce or fresh grass but some IC piggies can react with a flare to some foods they don't have on a pretty much daily basis.

PS: My Nerys had 3 years on it, then 3 years without any urinary tract issues at all before dying at the venerable age of 8 years from age related issues.

 

[xToNix]

@SkyPipDotBernie @Wiebke do you give cystease when there’s a flare or more frequently as a preventative measure please?

 

[DMS260820]

@SkyPipDotBernie @Wiebke do you give cystease when there’s a flare or more frequently as a preventative measure please?

I give it permanently now. I order 3 packs in bulk onlinr from vivovet and syringe feed everyday. I don't know if its doing anything, but it's worth a try. It's supposed to help line the bladder wall. My girl has just had stones flushed and a bad uti. I wouldn't bother using cystease with a healthy Guinea pig showing no signs of bladder problems

 

[furryfriends (TEAS)]

My vet says we should be feeding a wetter diet! I’ve never had a piggy with a bladder issue, but I feed a very wet diet with lots of grass and a large selection of veg and salad leaves. I made a thread about how I feed and you can find it here!
Feeding the guinea pigs at TEAS

 

[DMS260820]

My vet says we should be feeding a wetter diet! I’ve never had a piggy with a bladder issue, but I feed a very wet diet with lots of grass and a large selection of veg and salad leaves. I made a thread about how I feed and you can find it here!
Feeding the guinea pigs at TEAS

I'm still doing the wetter diet, when you think about it, in the wild they wouldn't need hay and would be eating just grass which has everything they need to survive. Vit c, tooth abrasion, hydration, and fiber.

Pellets i believe is something we are made to believe they need just because it's sold in every pet shop. But the amount of crap that's sold in pet shops for small animals that is unsuitable, makes me question pellets aswell