Bladder Sludge--Chippy's history

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Becky

Post   » Thu Oct 21, 2004 2:04 am


Info about Chippy and her sludge is scattered so I'm consolidating it here.


Background: When Chippy was approximately 3 1/2 years old, her litter mate (not confirmed, but pretty sure) died from kidney failure due to stones. I mention this because there seems to be a strong genetic component to stones.

Chippy was born approximately February of 1999. She is a TSW Peruvian.

Her adult weight has flucuated, but has stayed at between 990 and 1100grams since her spay.


March 2002: Chippy straining and crying while eliminating. Took x-ray. No stones. Cultured urine. No obvious bacteria but some white cells, possibly from contamination (not a sterile sample). Started TMS 0.4ml for ten days. Symptoms stopped.

July 2002: Noticed bright red blood spots on bedding. X-ray showed no stones. Started TMS for ten days.

September 2002: Chippy straining and crying in pain while eliminating. Noticed large, salt-sized chunks of gritty calcium deposits left on bedding.

Vet x-rayed. No stones, but large amount of sludge found in bladder. Began polycitra, 0.2ml mixed with 10X water twice a day with food.

Flushed bladder, did sterile urine culture. No blood or bacteria found. Started hydration subq's three times a week.

November 2002: Chippy has been passing blood and small blood clots approximately every 21 days. We've done two more cultures. No blood or bacteria found.

Bilateral hair loss and vet palpatated a small cysts on her ovary.

December 3, 2002 Vet performed a spay. Two days prior to the spay, Chippy had increased bleeding with fairly large clots.

Vet found one large cyst on one ovary and a second smaller cyst on the other ovary. He also took a tissue sample from her bladder. Result was chronic bladder inflammation and thickening of the bladder wall. (This, by the way, was the same results from Cookie's necropsy.)

Continued subq's, polycitra, meloxicam post-surgically and TMS for 14 days post surgery.

December 21, 2002: Chippy's urine is pink. Kept her on TMS for three weeks, post surgery. Vet suggests there might be an infection high up in the kidneys that isn't showing up on the culture.

Continuing subq's and polycitra. Changed all pigs' diet to a favorable Ca:Ph ratio.

December 30, 2002: Sterile urine sample was gritty, but much better than earlier samples. Sample tested positive for staph. Continued TMS.

After researching, Vet suggests another theory about "mystery" UTI's with no bacteria present might be caused by microbacteria that doesn't show up on culturing.

January 3, 2003: Chippy is crying again. Vet suggests we try giving her cosequin to coat the bladder, making it more difficult for bacteria to adhere to the bladder lining.

Started cosequin 0.4ml for 30 days and meloxicam for ten days.

January 18, 2003: We put Chippy on cosequin as a trial. She was given 0.4MLS once a day. The course of treatment was to be 30 days. This has not been used on pigs except in a few cases, as far as I know.

This is a treatment that has been successful in cats with transiet UTI's. My vet consulted with another vet who is trying this treatment. In addition, she was put back on 0.4MLS TMS when she once again exhibited signs of a UTI--crying when urinating, blood in urine. We continued her polycitra and she continued to get sqs three times a week.

Within a couple of days, Chippy's poos were pretty misshappen, seemed coated (which made sense) and had a porous quality to them, sort of like lava rock.

After four days, the poos were strung with mucus, so we stopped the cosequin. The poos were back to shape within 12 hours, but still soft and lava-like.

Vet checked her poos today. They had an overgrowth of yeast. She's on Nystatin for 7 days to deal with the yeast.

So...the theory was a good one concerning the cosequin. I was happy to try it. However, we've concluded that her GI system doesn't do well with it.

Next step, then...she'll be on TMS for six weeks to try to completely sterilize the bladder. He added meloxicam for 5 days to help with bladder inflammation.

X-ray showed no stones, no indication of sludge. Inflated the bladder for a closer look.

February 22, 2003: Follow-up vet visit. Took sterile urine sample directly from bladder. Urine as clear as the vet had ever seen in a guinea pig.

Going down to subq's twice a week. Continuing polycitra and Ca:Ph diet.

February 23, 2003: Believe it or not, Chippy crying again when eliminating. Started TMS and meloxicam.

--This pattern of crying, passing bloody mucus, continued about every four weeks or so. I would start the TMS and the symptoms would stop.

Vet recommended that I not give the TMS when the symptoms started to see what would happen. Symptoms still stopped after a day or two, so I discontinued giving TMS when symptoms begin.

April 19, 2003: A particularly bad episode of pain and bloody mucus.

Vet suggested we do an ultrasound to rule out adrenal gland tumors.

April 24, 2003: Took in two other sows for ultrasound as controls. All three sows had the same size adrenal glands. No indication of tumors or disproportionate adrenal glands.

Chippy had visable sludge in her bladder.

Longterm treatment: Vet and I discussed how to proceed. Obviously, she was in a cycle of inflammed bladder due to sludge which caused more sludge, more inflammation, etc.

The closest diagnosis we could come to was intertisal cystitis.

I continued subq's once a week and continued polycitra twice a day with meals, as well as the Ca:Ph diet.

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As Chippy had episodes of bloody mucus and pain, I administered injectable metacam 0.04ml as needed to control the inflammation. Generally, one shot was enough to stop the symptoms.

The episodes continue, but less frequently and less severly. I discontinued the subq's and she now takes metacam suspension, 0.2ml twice a day as needed. The concentration is 1.5mg/ml.

I no longer take her in for x-rays or urine cultures as the results were consistently negative for stones or bacteria.

------------

Chippy is extremely active, and is not bothered by these episodes. Once she is treated, she recovers quickly. She has maintained her weight and is as sassy as ever.

User avatar
Lynx
RESIST

Post   » Thu Oct 21, 2004 9:39 am


So, currently no polycitra? When you used it, it had to be given with water, right? Did you do this orally (how much if so)?

Thanks for the summary. I think this (and a few other conditions like some pododermatitis) are problems that are never really cured, only managed.

User avatar
Becky

Post   » Thu Oct 21, 2004 8:47 pm


Yes, she still gets polycitra twice a day. Sorry that wasn't clear.

Polycitra should always be taken with plenty of water...the pharmacist (yes, she knows it's for pigs) said ten times the amount at least.

I use a 3cc syringe and pull out 0.15ml. It's not as precise as a smaller syringe, but there doesn't seem to be any problem with not getting the dose exactly right. I eyeball it.

Then I put the same syringe and pull up water to the 2cc mark.

I believe one also could premix it. Since she's the only pig on meds right now (knock wood), that seems to work well.

User avatar
Becky

Post   » Fri Jul 07, 2006 11:46 am


I have a couple of updates for Chippy's history.

First, as she approaches the 7 1/2 year mark this month, she seemed to be slowing down even more than usual. She also has been going up and down on her weight, but always losing some in the end. Her weight at the last posting was 1020 grams. It now hovers around 910-920.

When her teeth started slanting, I took her in to have them checked out. They're generally OK, but he did comment that her bladder was not at all inflammed. Also, for the first time, she didn't have any pain while he was palpating her bladder. Knock wood, it appears that her chronic inflammation of the bladder no longer is inflammed.

She's been off the polycitra now for over a year and a half now and has metacam only if she cries for longer than a day. That's the odd part. She still cries a few times a week when she poos. So either something else, besides the inflammed bladder is going on, or it's due to the arthritis in her back.

The second update is unrelated to her bladder issues. I noticed she was particularly quiet, to the point of my being able to put my hand on her before she would wake up. Took her in for an x-ray that revealed a slightly enlarged heart and a pocket of fluid in her lungs. She had absolutely no other symptoms--no difficult or sticky breathing, no URI or discharge.

We've started her on Enalapril and Furosemide and will check with an x-ray in about a week.

Finally, the x-ray we took showed no signs of sludge or stones in the bladder.

User avatar
Becky

Post   » Sun Nov 05, 2006 12:29 pm


A week ago (October 29, 2006), I gave the girls some corn husks and silks. Chippy started wheeking as soon as I came into the room. About half an hour later, I brought up their dinner salad and found she had collapsed and died while eating her pellets. She would have turned 8 in early February.

Her necropsy was very revealing and I wanted to share it here for all the other sludge/IC pigs out there. First, though, a brief update.

During the past four months, she continued to lose weight and developed terrible, raspy breathing. We switched to lasix twice a day and the breathing improved. When we tried to wean her off the lasix, the bad breathing came back immediately, so she continued on twice daily lasix.

About a month ago, I took her in for a recheck and to discuss her heart meds. Dr. N. found a nodule in her abdomen and took a FNA. It indicated a reaction to inflammation with some odd spindals (I think that's what they were.) We put her on AB's and the nodule got smaller, but remained there.

During all of this time, she continued to have pain on occasions with a small amount of blood.

Necropsy results: Initially, he found that the heart looked normal. The lungs had several nodules, one of them quite large. He also found several lesions in her bladder. He sent out samples of the heart, lungs and bladder. I don't have the report yet, so the following is from a telephone conversation. I'll post the actual report when I get it.

HEART: She had chronic inflammation of the heart and this most likely caused her immediate death.

LUNGS: Her lungs were full of diffuse nodules and were cancerous--adenoid cystic carcinoma. The lasix probably kept her alive these past months by keeping the fluids out of her lungs.

BLADDER: Most pertinent to this thread, she had chronic severe inflamed cystitis. We knew she had inflamed cystitis so we now have a confirmed IC diagnosis.

Most surprising to my vet was that there was evidence of metaplasia. As I understand this, mature cells actually change or transform themselves into a different type of cell in reaction to injury or irritation (insult is the med term??). So, the sludge did much more damage than we ever imagined and it was permanent damage since she has had no signs of sludge now for several years now. The changed cells were cancerous.

In addition, he suspects this metaplasia is the cause for the heart and lung problems as well.

NOTE! He is changing his protocol from treating chronic cystitis from metacam to piroxicam (feldene). This drug also is a NSAID, however, it has an anti-tumor effect, especially for bladder cancer. This is something you might want to discuss with your vet if you have a pig with chronic bladder inflamation.

User avatar
Becky

Post   » Sun Nov 05, 2006 12:34 pm


As a final note, this is a very supportive board and I know so many of you want to pass on your condolences. Since this is a reference thread, I will accept them telepathically. I've had a week to get used to not having my Chippster around, and while it's sad not to see her stomping her little feet at me or to hear her special wheek, I have no regrets and no complaints.

Living as long as she did was pretty remarkable, particularly given all of her health issues. I am most grateful to her for giving all of us the opportunity to learn more about these little guys and maybe even more importantly, to teach my vet more about them.

Chippy sent me on my journey to find the perfect piggy diet. For that, I also thank her. She has graced us all with her unending patience during more poking and prodding than any little two-pound creature should have to endure.

Now it's her turn to rest.

HollyT
Get on your bike.

Post   » Sun Nov 05, 2006 12:37 pm


edit

User avatar
Becky

Post   » Sun Nov 05, 2006 1:46 pm


Holly's question had to do with whether or not this was true IC. There was no infection of the bladder or anywhere else. In fact, she's never had a urinary tract infection. The lack of infection and chronic inflamation would indicate true IC.

The only part that doesn't fit the IC diagnosis is the fact that she ended up with bladder cancer. Back when she was spayed and was having her most severe pain, we took a tissue sample from her bladder. It came back clear of infection and clear of cancer. From what I understand, human IC doesn't really progress into cancer. But perhaps that's the difference between humans and guinea pigs? I don't know.

HollyT
Get on your bike.

Post   » Sun Nov 05, 2006 2:39 pm


Using the word cystitis threw me off. Thanks for clearing that up for me.

User avatar
Becky

Post   » Mon Nov 06, 2006 10:16 pm


Cystitis can refer to any inflamation of the bladder, I believe. Not just infection.

That's my understanding, at any rate.

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