Urine problems- at a loss?!

[SianLorna]

Evening,

Long post alert!

I've read so many posts but would love some support. In Dec my 5 year (and 9 months) old female (Flapjack) had a UTI. She had pink urine/bacteria. She was placed on a course of antibiotics and once finished her urine was retested and there was no longer any blood or bacteria. However not long after the blood was present again in her urine but only spotted via dipstick, the colour was normal. My vet (who I trust very much) ran more tests. Multiple urine samples have been done, tested, cultured. No bacteria or crystals. Ultrasounds done, no stones/sludge. My vet deemed it was inflammation and suggested glucosamine. Flapjack is already on meloxicam (cat) for arthritis and she said when I notice blood via dipstick, I can double the amount of meloxicam until the inflammation has calmed down.

However I'm at a loss, we can go days/weeks without blood but then it bounces right back, usually with high calcium deposits/fishy smelling urine. The smell is what prompts me to test the urine which will usually show blood/ leukocytes on a dip stick a day or 2 later.

Flapjack eats well, does drink and will also drink more if I offer the bottle to her which I do on a regular basis during inflammation flares. She'll raise her front legs against the cage for veg/treat time etc and seems bright and alert.

Her diet consists of lots of hay (Timothy, meadow and orchard), fresh grass, urinary support treat tablets. Due to a bad case of bloat/stasis a year ago, she can literally only have bell pepper, Romain lettuce, baby corn and coriander. Even cucumber will cause her to bloat. Her water is filtered and she doesnt have pellets as she was never bothered by them and when I learnt they didn't really need them, I stopped buying them.

I guess I'm after some support or anything more I can do?! To keep her comfortable. She's never sqeaked when doing a wee and it very much seems to just be the blood (only seen via dipstick) and intermittent smelly wee. This past week we got a batch of hay that was more crunchy than normal with lots of seed heads. She loves the seed heads but since this hay she had LOADS of large calcium deposit wees and the smell was the worst it's ever been. So I've removed it from the cage and swapped with other hay and the amount of deposits/smell seems so slowly be calming down.

 

[Wiebke]

Evening,

Long post alert!

I've read so many posts but would love some support. In Dec my 5 year (and 9 months) old female (Flapjack) had a UTI. She had pink urine/bacteria. She was placed on a course of antibiotics and once finished her urine was retested and there was no longer any blood or bacteria. However not long after the blood was present again in her urine but only spotted via dipstick, the colour was normal. My vet (who I trust very much) ran more tests. Multiple urine samples have been done, tested, cultured. No bacteria or crystals. Ultrasounds done, no stones/sludge. My vet deemed it was inflammation and suggested glucosamine. Flapjack is already on meloxicam (cat) for arthritis and she said when I notice blood via dipstick, I can double the amount of meloxicam until the inflammation has calmed down.

However I'm at a loss, we can go days/weeks without blood but then it bounces right back, usually with high calcium deposits/fishy smelling urine. The smell is what prompts me to test the urine which will usually show blood/ leukocytes on a dip stick a day or 2 later.

Flapjack eats well, does drink and will also drink more if I offer the bottle to her which I do on a regular basis during inflammation flares. She'll raise her front legs against the cage for veg/treat time etc and seems bright and alert.

Her diet consists of lots of hay (Timothy, meadow and orchard), fresh grass, urinary support treat tablets. Due to a bad case of bloat/stasis a year ago, she can literally only have bell pepper, Romain lettuce, baby corn and coriander. Even cucumber will cause her to bloat. Her water is filtered and she doesnt have pellets as she was never bothered by them and when I learnt they didn't really need them, I stopped buying them.

I guess I'm after some support or anything more I can do?! To keep her comfortable. She's never sqeaked when doing a wee and it very much seems to just be the blood (only seen via dipstick) and intermittent smelly wee. This past week we got a batch of hay that was more crunchy than normal with lots of seed heads. She loves the seed heads but since this hay she had LOADS of large calcium deposit wees and the smell was the worst it's ever been. So I've removed it from the cage and swapped with other hay and the amount of deposits/smell seems so slowly be calming down.

Hi and welcome

I am very sorry for your desperation. Good that you have started a thread because you have likely been chasing the wrong hare with your searches.

Blood can be (and is often) present in many urinary tract infections but the deep red pees are generally caused by a natural dye called porphyrin and not lots of sheer blood or bloody pees.

Please consider that you and your vet may be dealing with a sterile (i.e. non-bacterial) cystitis and not a bacterial urine infection. Sterile cystitis has sadly become the most common form of urinary tract infection for indoors guinea pigs, due to the stressful environment of commercial mass breeding. It is characterised by a low (rarely zero) bacterial count despite the symptoms looking like a resistant UTI.

Sterile cystitis can only be managed but not healed. It can run the whole spectrum from the very mild to the most severe, which can be fatal in a matter of days. Most cases are somewhere in the medium range.

Because it is something that has only become more common over the last two decades with the rise of countrywide pet shop chains, many vets who do not see guinea pigs much, are not aware of it. The illness mirrors that of FSC (feline sterile cystitis) and so does treatment with metacam and glucosamine; this is the access to take with vets who are not conversant with sterile cystitis in guinea pigs (formerly known in guinea pig circles as interstitial cystitis (IC) if you want to look for more information.

The illness affects especially the natural insulating glucosamine coating of the urinary tract, which prevents highly corrosive urine from coming into direct contact with raw tissue. Glucosamine, which is classed as a food supplement and is not prescribed by vets and you will have to get that yourself. We can advise once you have a diagnosis.
Once you have got on top of the initial symptoms, you will experience regular flare up (hence the old name 'recurring cystitis').

You may find this link here to our forum guide with an overview over the urinary tract helpful and if necessary can show it to your vet: Wiebke's Guide to Pees and Stones

You and your vet may also find this printable fact sheet from the Royal Veterinary College (RVC) with a very short overview over urinary tract information, diagnosis and treatment interesting: Guinea pig cystitis information and advice 2022

I hope that this helps you.
Your priority is to get a diagnosis. We are here for you for ongoing moral and practical support as it is going to take a while to get on top of a sterile cystitis and the flares, especially the first ones tend to be rather upsetting as well.

 

[SianLorna]

Hi and welcome

I am very sorry for your desperation. Good that you have started a thread because you have likely been chasing the wrong hare with your searches.

Blood can be (and is often) present in many urinary tract infections but the deep red pees are generally caused by a natural dye called porphyrin and not lots of sheer blood or bloody pees.

Please consider that you and your vet may be dealing with a sterile (i.e. non-bacterial) cystitis and not a bacterial urine infection. Sterile cystitis has sadly become the most common form of urinary tract infection for indoors guinea pigs, due to the stressful environment of commercial mass breeding. It is characterised by a low (rarely zero) bacterial count despite the symptoms looking like a resistant UTI.

Sterile cystitis can only be managed but not healed. It can run the whole spectrum from the very mild to the most severe, which can be fatal in a matter of days. Most cases are somewhere in the medium range.

Because it is something that has only become more common over the last two decades with the rise of countrywide pet shop chains, many vets who do not see guinea pigs much, are not aware of it. The illness mirrors that of FSC (feline sterile cystitis) and so does treatment with metacam and glucosamine; this is the access to take with vets who are not conversant with sterile cystitis in guinea pigs (formerly known in guinea pig circles as interstitial cystitis (IC) if you want to look for more information.

The illness affects especially the natural insulating glucosamine coating of the urinary tract, which prevents highly corrosive urine from coming into direct contact with raw tissue. Glucosamine, which is classed as a food supplement and is not prescribed by vets and you will have to get that yourself. We can advise once you have a diagnosis.
Once you have got on top of the initial symptoms, you will experience regular flare up (hence the old name 'recurring cystitis').

You may find this link here to our forum guide with an overview over the urinary tract helpful and if necessary can show it to your vet: Wiebke's Guide to Pees and Stones

You and your vet may also find this printable fact sheet from the Royal Veterinary College (RVC) with a very short overview over urinary tract information, diagnosis and treatment interesting: Guinea pig cystitis information and advice 2022

I hope that this helps you.
Your priority is to get a diagnosis. We are here for you for ongoing moral and practical support as it is going to take a while to get on top of a sterile cystitis and the flares, especially the first ones tend to be rather upsetting as well.

Thank you @Wiebke for the support! I've got another appt tomorrow for a urine sample check. Flapjacks wee's are never red, the blood presence is only seen via dipstick and this is intermittent. She can go days/weeks with clear samples- I tend to do random spot checks when I'm cleaning her out just so I can guage where we're at. She's on cat metacam and I've been giving her feliway cystease since the beginning of Jan, which my vet advised. I was advised to do 2 capsules a day for the first week then drop to 1 capsule a day.

The stress/mental drain during the flares can be tiring. The provided documents is interesting, thank you!

Does excess calcium irritate the bladder/contribute to flare ups? I try to keep her on a low calcium diet but for some reason this latest hay batch I got caused large calcium deposits. They're not gritty and she doesn't squeak (again tomorrow I'll ask for crystals to be looked for) I've removed the hay now as this was the only 'new' thing I'd introduced and just over a day after, the calcium wees were out in full force.

 

[Wiebke]

Thank you @Wiebke for the support! I've got another appt tomorrow for a urine sample check. Flapjacks wee's are never red, the blood presence is only seen via dipstick and this is intermittent. She can go days/weeks with clear samples- I tend to do random spot checks when I'm cleaning her out just so I can guage where we're at. She's on cat metacam and I've been giving her feliway cystease since the beginning of Jan, which my vet advised. I was advised to do 2 capsules a day for the first week then drop to 1 capsule a day.

The stress/mental drain during the flares can be tiring. The provided documents is interesting, thank you!

Does excess calcium irritate the bladder/contribute to flare ups? I try to keep her on a low calcium diet but for some reason this latest hay batch I got caused large calcium deposits. They're not gritty and she doesn't squeak (again tomorrow I'll ask for crystals to be looked for) I've removed the hay now as this was the only 'new' thing I'd introduced and just over a day after, the calcium wees were out in full force.

In our collective forum experience, calcium is not involved in sterile cystitis but going too low can lead to bladder problems. There is a balanced sweet spot between calcium, phosphorus and potassium in the diet, either side of which you get problems.

What can trigger flares in some piggies and in the higher ranges of sterile cystitis are dietary changes.

Large calcium wees are usually characteristic for the onset of a flare, followed by the intense red pees before the squeaking starts but the calcium pees do not necessarily signal an imbalance when it comes to sterile cystitis, so I would not worry about your diet being too high in calcium. It's basically just the different hay that is causing a new flare. Anything new needs to be very slowly and gradually introduced.

It takes a while to 'learn' your own piggy's SC quirks. Initially, it can be rather overwhelming and stressful but you will eventually get the hang off it and learn what works best to get on top of a flare quickly; like shortly upping the glucosamine and metacam for 2-3 days to bring the flare down etc.
Don't be afraid of experimenting a bit. This is a marathon and you have to find your own stride pattern. Once you get a bit more of a sense of it then it won't be quite as frightening.

Sterile cystitis piggies are generally piggies with a naturally high stress default level; healthy companions can usually fend it off with their own immune system. But the illness itself is a little different with every piggy.

You can ask your vet for dog metacam if it makes it easier for long term support but it is the glucosamine that is crucial for minimising the pain quickest and for general comfort.

I hope that this helps you?

 

[SianLorna]

Evening @Wiebke,

Thank you! Urine analysis and ultrasound came back clear on Friday. Kidney function etc was healthy too. We read through the documents you attached and my vet is happy to say IC is what flapjack has. Like you mentioned, it's not something she was familiar with in GP and it's a learning curve for both of us.

The new dietary changes is interesting and makes complete sense! Although the hay variety itself wasn't new, the batch was so different to what we usually receive and I think that's where the flare came from. I'll have to play around with the calcium diet and find the sweet spot as I wonder if I've dropped her too low (filtered water, no pellets).

Thank you again for the support

In our collective forum experience, calcium is not involved in sterile cystitis but going too low can lead to bladder problems. There is a balanced sweet spot between calcium, phosphorus and potassium in the diet, either side of which you get problems.

What can trigger flares in some piggies and in the higher ranges of sterile cystitis are dietary changes.

Large calcium wees are usually characteristic for the onset of a flare, followed by the intense red pees before the squeaking starts but the calcium pees do not necessarily signal an imbalance when it comes to sterile cystitis, so I would not worry about your diet being too high in calcium. It's basically just the different hay that is causing a new flare. Anything new needs to be very slowly and gradually introduced.

It takes a while to 'learn' your own piggy's SC quirks. Initially, it can be rather overwhelming and stressful but you will eventually get the hang off it and learn what works best to get on top of a flare quickly; like shortly upping the glucosamine and metacam for 2-3 days to bring the flare down etc.
Don't be afraid of experimenting a bit. This is a marathon and you have to find your own stride pattern. Once you get a bit more of a sense of it then it won't be quite as frightening.

Sterile cystitis piggies are generally piggies with a naturally high stress default level; healthy companions can usually fend it off with their own immune system. But the illness itself is a little different with every piggy.

You can ask your vet for dog metacam if it makes it easier for long term support but it is the glucosamine that is crucial for minimising the pain quickest and for general comfort.

I hope that this helps you?

 

[Wiebke]

Evening @Wiebke,

Thank you! Urine analysis and ultrasound came back clear on Friday. Kidney function etc was healthy too. We read through the documents you attached and my vet is happy to say IC is what flapjack has. Like you mentioned, it's not something she was familiar with in GP and it's a learning curve for both of us.

The new dietary changes is interesting and makes complete sense! Although the hay variety itself wasn't new, the batch was so different to what we usually receive and I think that's where the flare came from. I'll have to play around with the calcium diet and find the sweet spot as I wonder if I've dropped her too low (filtered water, no pellets).

Thank you again for the support

Instead of pellets, you can introduce fresh or dry forage.

Veg, fresh and dry forage, pellets and any treats all together replace the role of wild forage so you can for instance without problems feed a slice of kale or (collard) greens once a week - provided you always introduce any new foods in small quantities as part of a veg mix and never on their own in order to minimise the risk of a flare. Give the gut microbiome time to grow the specialist bacteria over several days.
That is why fresh grass or lettuce has got a bad reputation because it was not introduced slowly and gently enough.

For glucosamine we are finding Johnson's 4joints strong dog liquid best and comparatively cheaply to give. It is widely available online and in pet shops and most piggies like the taste of it. Give 0.4 ml to a 1000g piggy once daily and adapt the amount accodingly if your piggy is significantly smaller or bigger. Be aware that it can take a few weeks for the glucosame to build up in the urinary tract in order to be effective.

It is a learning curve but once you have worked out how high with metacam you have to go with a flare and how low you can go in the interims it does work for the longer term. Mild to medium cases often go away on their own eventually with gradually widening interstitial periods but you are looking at years rather than months.

My Nerys (the large teddy in my avatar on the left) had sterile cystitis for 3 years and then spent another 3 years free of any bladder issues to eventually pass away from old age after her 8th birthday in 2016. Just to give you a head up.

 

[SianLorna]

@Wiebke I have dried forage that contains flowers, nettles, dandelion etc but I stopped as I was worried about the calcium- I'll try again in small amounts.

She's currently on cystease, would you say the Johnson's 4joints is a better choice? She weighs 1.2kg. Swapping to the Johnson's would be handy instead of breaking open the cystease capsules every day!

 

[Wiebke]

@Wiebke I have dried forage that contains flowers, nettles, dandelion etc but I stopped as I was worried about the calcium- I'll try again in small amounts.

She's currently on cystease, would you say the Johnson's 4joints is a better choice? She weighs 1.2kg. Swapping to the Johnson's would be handy instead of breaking open the cystease capsules every day!

Cystease has got some added products specially for calming the bladder while 4joints is more geared towards coating bones but the glucosamine is the same.

You can see which works better for you. I would recommend to do finish the cystease and then see whether the 4joints works better for you. It is a bit of a trial and error thing. But at least you know that the cystease seems to be working for you.

I used the 4joints for a new (milder) case of sterile cystitis when I had it already at home for my arthritic oldies and it did seem to do the trick as well, saving me having to splash out on extra cystease.

 

[guineapigmom04]

Hi weibke,

My piggy was just diagnosed with ic, I have been trying to find info on it but not having much luck, will floor time make the flair ups worse do you know? I know it is different for each piggy

Thank you in advance