A couple of info that could be useful, please expert members give input

[LunaticPoodle]

Hi everyone, just wanted to share a couple things that came up on my last vet visit about 2 weeks ago. I'd like to hear expert opinions though.
So, Geezer isn't having the best year so far- 3 hay pokes, of which one required emergency vet intervention, and more recently blood in urine. Ultrasound showed a 3mm bladder stone attached to the bladder wall. I have adjusted his diet, he's been a week on antibiotics (Borgal), rabbit Fibreplex 2 hours after, and the vet prescribed 0.8 ml Metacam. I was taken aback as I thought it was a massive dose, so I gave him only 0.5, however at the following checkup his usual vet told me that it's been recently established that painkiller dosage for Guinea Pigs has been too low and new guidelines give a higher dosage. Geezer is just short of 1kg 300g. So, thought this info might be useful. Has anyone here used that much Metacam on a piggie? Dog Metacam btw. So here's that.

Another thing that happened, during the last 4 days before the check up, and another 3 days after, I gave him 2ml twice a day of Chanca Piedra tea. Now, I know no one has had any results in a while, and it could be unrelated, but during the ultrasound we could clearly see pieces of the stone tipping down in his bladder, so it was indeed breaking up. All good till last night, I think there was again some blood in his urine. He hasn't been complaining, but I'm putting him back on Metacam and tea for a few days just to be safe. If I see more blood or he starts complaining it's back to the ultrasound and probably surgery, which terrifies me.
Just wanted to see what you guys think about the tea. I made a light-ish one, 1liter of water with 1 and a half tablespoons of Chanca Piedra loose leaves.
Hugs

P.S. I tried feeding him the leaves but he won't have it, I'm considering making some hay cookies in the dehydrator with added Chanca Piedra. Can't hurt, right?

 

[Betsy]

My RB Piggy Silver Fox Christian had arthritis in his spine and he was prescribed 0.7ml twice a day of dog Metacam which I managed to slowly reduce to 0.5ml twice a day under vet advice. I was told exactly the same as you about Metacam by my vet and this was a good few years ago now. Christian was on Metacam for the rest of his life. I was told the higher dose may shorten his life a bit but I chose a pain free (potentially) shorter life for him than a (potentially) longer life of pain. He still lived until he was nearly 5.

 

[LunaticPoodle]

Thank you for reassuring me, I'm fairly new to all this. I think you made the right choice too and I'm sorry you had to choose.
I live across the street from the only animal hospital in the region, they aren't super amazing with exotics though, but this one vet seems pretty good with small animals. One particular nurse in the emergency room was actually awesome. For the surgery we'll have to take him to a different vet, as they don't do that here. She's a bit outside town but not very far, and the only one who has serious experience with exotics in the area. The actual specialised exotics clinic in the country is like 200 km from here, so I'm skeptical about making him travel 2 hours in the car to go to surgery and another 2 hours back...

 

[Wiebke]

Hi everyone, just wanted to share a couple things that came up on my last vet visit about 2 weeks ago. I'd like to hear expert opinions though.
So, Geezer isn't having the best year so far- 3 hay pokes, of which one required emergency vet intervention, and more recently blood in urine. Ultrasound showed a 3mm bladder stone attached to the bladder wall. I have adjusted his diet, he's been a week on antibiotics (Borgal), rabbit Fibreplex 2 hours after, and the vet prescribed 0.8 ml Metacam. I was taken aback as I thought it was a massive dose, so I gave him only 0.5, however at the following checkup his usual vet told me that it's been recently established that painkiller dosage for Guinea Pigs has been too low and new guidelines give a higher dosage. Geezer is just short of 1kg 300g. So, thought this info might be useful. Has anyone here used that much Metacam on a piggie? Dog Metacam btw. So here's that.

Another thing that happened, during the last 4 days before the check up, and another 3 days after, I gave him 2ml twice a day of Chanca Piedra tea. Now, I know no one has had any results in a while, and it could be unrelated, but during the ultrasound we could clearly see pieces of the stone tipping down in his bladder, so it was indeed breaking up. All good till last night, I think there was again some blood in his urine. He hasn't been complaining, but I'm putting him back on Metacam and tea for a few days just to be safe. If I see more blood or he starts complaining it's back to the ultrasound and probably surgery, which terrifies me.
Just wanted to see what you guys think about the tea. I made a light-ish one, 1liter of water with 1 and a half tablespoons of Chanca Piedra loose leaves.
Hugs

P.S. I tried feeding him the leaves but he won't have it, I'm considering making some hay cookies in the dehydrator with added Chanca Piedra. Can't hurt, right?

Hi

The metacam dosage is perfectly OK and not even at the maximum level for a 1300g boar.

Please split it in two and give 0.4 ml every 12 hours to ensure constant cover. Guinea pigs have a much faster metabolism that cats, dogs, or even rabbits. In my own experience with guinea pigs in great pain, metacam starts wearing off about 10 hours.
Chanca piedra has in our own experience not even once worked with any of the forum piggies whose owners were desperate enough to try it over the last 15 years. I am not saying that it may not do so episodically but it certainly doesn't do so consistently enough to recommend it to anybody on here as a feasible treatment; the same goes unfortunately for all the other stone dissolving stuff that has been tried.
An operation is generally still the only way of dealing with bladder stones. If the chanca piedra is actually working for you or the stone is disintegrating on its own, then count yourself very lucky!
It may be that the stone has crumbled enough to come off the wall with some bleeding or may have sratched the walls of the urethra when being peed out. Only an x-ray will tell.
Please always contact your vet if experience bleeding in a bladder piggy. You and your vet may want to consider whether using a glucosamine based cat bladder supplement would help with the discomfort in the bladder walls. Guinea pigs have an insulation natural glucosamine coating that prevents the highly corrosive urine from coming into direct contact with raw tissue. Glucosamine itself is not classed as a medication but as a food supplement so it should be easily available online.

Please review your diet. More calcium comes with pellets and water (especially hard water); most owners are not aware of that. Please limit the pellet intake to 1 tablespoon per piggy per day; weight by weight, pellets contain noticeably more calcium than even the veg highest in it, kale. The more pellets you feed at the cost of piggies eating hay, the more life-shortening that is. My piggies have started to live another 1-2 years longer on average after I made that change a decade ago together with changes to the veg diet. I've only had one bladder stone piggy in the last 9 years (out of adopting ca. 50 piggies in the meantime) compared to previous years, and that was in the wake of fresh veg supply issues in the run up to and during the first Lockdown at the start of the pandemic.
We recommend to filter water even in soft water areas as minerals can also contribute to the build up of stones; it really makes a big difference for bladder stone piggies. For those where other factors are in play that do not react as well to dietary measures, low calcium bottles water may be considered.
You also want to cut out certain veg/fruit food groups that are high in oxalates or not healthy to feed more than as an occasional treat in small quantities. The greener and leafier the diet, the better. Please keep in mind that veg (ca. 15-20%) and pellets (ca.5%) only replace the supplementary role that wild forage used to have in addition to the
three quarters of hay/grass that make the bulk of a health daily diet. The closer you come to a natural diet, the better.
You may find some of our diet advice likely a bit surprising but we know that it does work and that it does not only minimise the occurrance of stones but also boosts general health and longevity.
If your piggy is not a great natural drinker, then try to feed a bit more fresh green dog pee and pesticide-free grass (incidentally it is high in vitamin C but needs to be introduced carefully), cucumber and lettuce to encourage regular large bladder flushing pees in order to minimise the build up of more stones. The calcium absorption process is complex and quite a bit can go wrong. Diet is unfortunately the only way we can manipulate it. The aim is NOT to cut out all calcium out of the diet (too little calcium is every bit as detrimental as too much) but to find a certain balanced sweet spot, which depends to an extent on local factors, so there is no perfect recipe for everybody. If the cause of the stone is genetic and not diet related, then a diet can at least help to minimise a recurrence in the long term; any dietary changes take several weeks until any excess calcium is worked out of the body so any diet change is not a quick fix mixture.
Here is our comprehensive diet link. In addition to the general diet, you can find a chapter for piggies with urinary tract issues: Long Term Balanced General And Special Needs Guinea Pig Diets

 

[Eriathwen]

I've currently got a handful of piggies on dog metacam and they get from 0.8ml to 1.2ml twice a day, I go through so much of it I've just started getting the 180ml bottles! it's definitely been very under dosed in the past, thankfully dosing is slowly changing. I remember a few years back only being given 0.2ml once a day after surgeries.
I've only ever used chanca piedra as a preventative so can't comment on that.

 

[LunaticPoodle]

Thank you so much, I absolutely adore you!
I'll look into filtering the water. In our area it's very, very soft, for example my husband's old washing machine lasted him 20 years... But it can't hurt!
I was definitely overfeeding them kale in the past, nowadays I only give them a bit as a treat, cos they love it.
About their diet, I feed them daily:
lettuce (not romaine), green pepper (they prefer it to red and yellow, but eat those too occasionally), fennel and cucumber; on a rotation in addition to that basic salad they get more or less:
cherry tomato once a week
a slice of carrot twice a week
a piece of fruit on the weekend (apple, banana, seedless grape- they're not big fans of other fruit, maybe blueberries and wild strawberries when we go to the forest in summer)
a string bean
endive
kale once a month (I used to feed it every day the first 5 months I had piggies. Rookie mistake. Sorry.)
pea shoots, cilantro, mint, wheatgrass, basil, parsley, thyme or dill as an afternoon snack. I'm trying to keep it to mint and cilantro mainly lately.
In summer they get dandelion leaves and plantain (fresh) and whatever safe stuff we can find in the forest- still learning so I keep to the easy ones
Powdered Vitamin C every other day on their veggies.

As pellets they get locally made organic pressed hay and as a treat some Oxbow garden select in their treat balls.
They occasionally have some of the Oxbow support cookies, mainly the Vit C ones and urinary support, the other types as needed.
Pea flakes: they definitely have too much. Working on cutting back (got the Oxbow pellets to use as a substitute treat).

About the Chanca Piedra tea, it's likely that simply the added water intake (extra 4 ml a day for a piggy that drinks very little) is what did the trick. Seems weird that it would have worked in only 4 days and especially the one time in 15 years that no one has had any success to report, so yeah, I agree with you guys.
Thank you again so, so much!

 

[Wiebke]

Please cut down on fruit and 'treat veg' and only give any treat (whether that is fruit or veg) once or twice in the week. Keep in mind that a change in forage is every bit as interesting as lots of different fruits and carrots etc, which are much more important for a human diet than they are for a cavy one. It is very easy for any loving owner to fall into that trap!
They will distract ultimately from eating hay/fresh grass as much as possible - and that is where health and a long life ultimately come from.
There is a soft spot in the diet where the calcium/oxalates balance is just right. But keep a hold on any pellets and do not overdo the vitamin C - there is enough in a normal diet. I hope that you are aware that fresh green grass is rich in vitamin C, which is the main reason why they never needed to make their own and could switch that gene off. But if you reduce any vitamin C supplementing, do so carefully or you will end with scurvy symptoms; not because of lack of vitamin C but because the body has got used to high levels and will react with scruvy even though the levels are still well above normal.
Can I assure you that in 15 years, none of our long term forum owners' piggies have ever needed to be treated for scurvy but that most of the scurvy cases we encounter are from overdoing cases?
Keep in mind that piggies would have rarely encountered fruit and would not have eaten high sugary/fatty treats like carrot - the occasional roots would have been rather small as they are not diggers. the more natural you can keep their diet, the better.

 

[LunaticPoodle]

Thank you so much again, you really are a great teacher.
They aren't big fans of fruit anyway, I doubt they're going to miss it
Grass: we can grow wheatgrass at home, is that the same (we give them wheatgrass as a snack sometimes and they are crazy about it)? Cos we lack a garden. My mother in law lives in the countryside, but it's been too cold even in summer to have piggies outside (in a covered run strictly, there's birds of prey at the very least). They can have grass and fresh forages only in summer here unfortunately.
Do dried forages count as treats or normal diet?

Their pellets are just pressed hay, there's nothing else in them. The Oxbow ones are very tiny and I only use them to distract them (only a couple pellets) when they get annoyed at having to wait for floor time- I have 5 boars and they have to wait for their turn, only 2 of them are cagemates. Rowdy youngsters. They get a pinch of either pellets a day, no more.

I have read somewhere that too much vitamin C can encourage the formation of urinary stones, and I do think they get too much. I was overcautious being a new piggy mom. They eat their hay, veggies, every 48 hours the supplement, if no supplement on the veggies (they probably taste it and tend to try and avoid it) they have the Oxbow cookie or another Vit C tablet. Seems indeed a bit excessive. They are all still young after all, and I still took Tony's needs as a model, while he was a senior with health issues.

Glucosamine: I was using a supplement specifically for rodents with urinary problems, he loves the taste, but I ran out. The blood in urine happened regardless. This one: Almapharm allrodin UTI Kn - Double Pack - 2 x 125 Tablets : Amazon.de: Pet Supplies

After just one dose of Metacam he's back to his bouncy self, more popcorning than usual even. I'm going to keep an eye on his peeing, give him Metacam for the rest of the week, try to get him to drink more water, and see if he manages to pee the rest of the sludge out. If not, we'll take another ultrasound and plan surgery. He always had a sludge problem even as a baby. I am on vacation at the moment so it would be a great time if surgery is indeed required.
Thank you for sharing your knowledge, I have learnt so much from your articles. I'm going to keep studying of course!
Today our Eppu turns one btw! They grow so fast

 

[Wiebke]

Thank you so much again, you really are a great teacher.
They aren't big fans of fruit anyway, I doubt they're going to miss it
Grass: we can grow wheatgrass at home, is that the same (we give them wheatgrass as a snack sometimes and they are crazy about it)? Cos we lack a garden. My mother in law lives in the countryside, but it's been too cold even in summer to have piggies outside (in a covered run strictly, there's birds of prey at the very least). They can have grass and fresh forages only in summer here unfortunately.
Do dried forages count as treats or normal diet?

Their pellets are just pressed hay, there's nothing else in them. The Oxbow ones are very tiny and I only use them to distract them (only a couple pellets) when they get annoyed at having to wait for floor time- I have 5 boars and they have to wait for their turn, only 2 of them are cagemates. Rowdy youngsters. They get a pinch of either pellets a day, no more.

I have read somewhere that too much vitamin C can encourage the formation of urinary stones, and I do think they get too much. I was overcautious being a new piggy mom. They eat their hay, veggies, every 48 hours the supplement, if no supplement on the veggies (they probably taste it and tend to try and avoid it) they have the Oxbow cookie or another Vit C tablet. Seems indeed a bit excessive. They are all still young after all, and I still took Tony's needs as a model, while he was a senior with health issues.

Glucosamine: I was using a supplement specifically for rodents with urinary problems, he loves the taste, but I ran out. The blood in urine happened regardless. This one: Almapharm allrodin UTI Kn - Double Pack - 2 x 125 Tablets : Amazon.de: Pet Supplies

After just one dose of Metacam he's back to his bouncy self, more popcorning than usual even. I'm going to keep an eye on his peeing, give him Metacam for the rest of the week, try to get him to drink more water, and see if he manages to pee the rest of the sludge out. If not, we'll take another ultrasound and plan surgery. He always had a sludge problem even as a baby. I am on vacation at the moment so it would be a great time if surgery is indeed required.
Thank you for sharing your knowledge, I have learnt so much from your articles. I'm going to keep studying of course!
Today our Eppu turns one btw! They grow so fast

If he has had sludge issues as a baby, then it is likely that he is suffering from a strong genetic disposition. This is a situation where what you can do is rather limited. You can optimise the diet in order to give the body less ammunition to make stones but in that case it is very hard to prevent them completely; all you can do is slow down the process and ideally keep it to sludge.
Upping the amount of watery veg like cucumber and lettuce to encourage at least one or two larger, strong pees can help with urination in bladder stone piggies that are very bad natural drinkers but water has to always be the preferred option. Our veg diet recommendations come basically down to a mix of medium to (in smaller quantity) higher calcium green leafy veg and forage and some low calcium watery veg.
When in season, fresh dandelion is also a good and often more easily available forage food which you can even grow at home from some foraged seed. It is a mildly diuretic (even though it is medium calcium), so encourages stronger peeing and is a good accompaniment to any fresh food portion.

You have do reduce any excess vitamin C very gradually in order to allow the body to get used to lower levels and avoid acute scurvy symptoms. This also goes for any humans on a high level of supplements; you cannot just stop them from one day to another.

Wheatgrass should be more in the way of an enrichment treat; it is a bit richer than normal grass.
Any dry forage means that the water has evaporated and that it is higher in calcium, so you better use dry forage more as a treat in terms of how much you feed, compared to fresh forage, which counts as veg.

You are a very caring and careful piggy mummy.

 

[LunaticPoodle]

Awww thank you! I'm going to keep better track of the amounts of veggies they eat. Time to make a spreadsheet Geezer is the only one who occasionally has urinary issues, even Surma who does not drink AT ALL never complained while weeing. Rutto and Baldrick are good drinkers, Eppu is so-so, Geezer drinks very little and Surma never touches his water except sometimes in summer when it's very hot. (he also gets a water bowl cos he likes to freshen his paws in it. It's hilarious!)
Your wealth of knowledge is an absolute goal and I'm really thankful for your support! Cheers!

 

[Wiebke]

Awww thank you! I'm going to keep better track of the amounts of veggies they eat. Time to make a spreadsheet Geezer is the only one who occasionally has urinary issues, even Surma who does not drink AT ALL never complained while weeing. Rutto and Baldrick are good drinkers, Eppu is so-so, Geezer drinks very little and Surma never touches his water except sometimes in summer when it's very hot. (he also gets a water bowl cos he likes to freshen his paws in it. It's hilarious!)
Your wealth of knowledge is an absolute goal and I'm really thankful for your support! Cheers!

You will find that if you offer more water in edible form that the amount of water drunk will reduce. The issue is that piggies do not become any thirstier just because you offer more fluid in different forms; it's a common mistake that many well meaning owners make. The individual fluid need (thirst) varies enormously in guinea pigs. They are not drinking over their thirst just because piggy mummy thinks that they should...
All About Drinking And Bottles

If all your other piggies are healthy and doing well without urinary tract issues, then your diet is already pretty well balanced and nothing to fret over majorly. You just have a piggy with a strong genetic disposition, which is to a good extent out of your control. The discussed little tweaks will hopefully help to optimise your good work.

 

[LunaticPoodle]

Indeed, the first few months we had piggies we were overfeeding them veggies (like twice the reccomended amount!) and they didn't touch their water. After we reduced their veggies to a normal amount (still a bit too much, but getting to normal quantities now) and with the example of a new cagemate after Tony passed away, Geezer started occasionally drinking. His sludge problem had almost disappeared till now. Thanks again for the great guidelines!

 

[Wiebke]

Indeed, the first few months we had piggies we were overfeeding them veggies (like twice the reccomended amount!) and they didn't touch their water. After we reduced their veggies to a normal amount (still a bit too much, but getting to normal quantities now) and with the example of a new cagemate after Tony passed away, Geezer started occasionally drinking. His sludge problem had almost disappeared till now. Thanks again for the great guidelines!

I hope that you can balance out the diet to not having any more stones.

 

[LunaticPoodle]

Hi again, so, the day before yesterday I found bloodstains around the cage again, and more on the liner under the couch. Geezer had been complaining while peeing during the day, so that was expected. The vet after his last ultrasound classified it as sludge, seeing as it was disintegrating before our eyes and said no surgery for the time being. He's been back on Metacam and tea for a few days. I did find a small piece of stone on the liner and searched for more but there was only the one (that I could find). Likely what caused the extra bleeding. No more blood or complaining after that. He's been drinking water, especially on that day. I've been out foraging for grass and slowly reducing their vitamin C, and he's been taking the syringe all by himself, good boy! So there's a little progress. The other guys are all doing fine, moving all the cages to the ground made a world of difference , as they can come and go as they please (even though within their turn for floor time) and everyone can interact with everyone. I absolutely hate, hate, hate seeing a piggy in pain though. Argh. I'd rather be in pain myself, darn it.

 

[Wiebke]

Hi again, so, the day before yesterday I found bloodstains around the cage again, and more on the liner under the couch. Geezer had been complaining while peeing during the day, so that was expected. The vet after his last ultrasound classified it as sludge, seeing as it was disintegrating before our eyes and said no surgery for the time being. He's been back on Metacam and tea for a few days. I did find a small piece of stone on the liner and searched for more but there was only the one (that I could find). Likely what caused the extra bleeding. No more blood or complaining after that. He's been drinking water, especially on that day. I've been out foraging for grass and slowly reducing their vitamin C, and he's been taking the syringe all by himself, good boy! So there's a little progress. The other guys are all doing fine, moving all the cages to the ground made a world of difference , as they can come and go as they please (even though within their turn for floor time) and everyone can interact with everyone. I absolutely hate, hate, hate seeing a piggy in pain though. Argh. I'd rather be in pain myself, darn it.

All the best. Have you discussed the glucosamine supplement as that will make a difference with the discomfort in the longer term.

 

[LunaticPoodle]

Ouch I forgot to ask! Thank you

 

[LunaticPoodle]

Hey y'all, he peed the stones out! He was in massive pain yesterday, crying and complaining and there was again bloodstains on the liner. I gave him an early dose of Metacam, took him to the bathroom and fed him some cucumber on a white towel (blood every time with the pee), checked his willy but it was clean... Then I just saw them when he moved over. Saved them in a little jar so the vet can tell me exactly what they're made of. A bigger one and a tiny one. Poor baby. That should be it, the 3mm stone had broken up in 3 pieces at his last ultrasound, and I found one a few days ago. I'm taking him to another one asap. Probably will need some more antibiotic, but I'll bring another urine sample just to be sure.
I'm waiting for my vet to call me back about the glucosamine but I mean, it's known it helps. I've spent the last few days reading studies about it too, and you all have had positive experiences with it.
Thank you all so much for the advice, these small changes have helped him enormously!

 

[Wiebke]

Hey y'all, he peed the stones out! He was in massive pain yesterday, crying and complaining and there was again bloodstains on the liner. I gave him an early dose of Metacam, took him to the bathroom and fed him some cucumber on a white towel (blood every time with the pee), checked his willy but it was clean... Then I just saw them when he moved over. Saved them in a little jar so the vet can tell me exactly what they're made of. A bigger one and a tiny one. Poor baby. That should be it, the 3mm stone had broken up in 3 pieces at his last ultrasound, and I found one a few days ago. I'm taking him to another one asap. Probably will need some more antibiotic, but I'll bring another urine sample just to be sure.
I'm waiting for my vet to call me back about the glucosamine but I mean, it's known it helps. I've spent the last few days reading studies about it too, and you all have had positive experiences with it.
Thank you all so much for the advice, these small changes have helped him enormously!

All the best and so glad for you that the stone has come out on its own.

Perhaps it has made the difference in that it was only a rather small one. Most stones are considerably larger by the time they cause real problems.

Glucosamine is like giving the walls of the urinary tract an extra layer of insulating paint. It takes a little way to get there, though but it really helps with the comfort in patching up all the places where the natural paint has come off. It is not classed as a medication, but as a food supplement, which is why don't don't normally prescribe it.

 

[LunaticPoodle]

Thanks He is still squeaking loudly when I pick him up, as careful as I try to be. But I'm sure the worst has passed. Tomorrow at 11.00 we're going to the vet. I bought a water filter, Feliway Cystease, his old urinary support tablets (German brand, doesn't have the sugary component the Oxbow ones have and they are all crazy about them, so that's a plus), urine test strips just for extra peace of mind, a set of syringe nipples in case he or the others find it more comfortable to drink like that... So bye bye summer bonus, but anything for my boys. I had to quit smoking but it's 100% worth it. No worries, never smoked in the house anyway

 

[LunaticPoodle]

Went to the forest to get them some grass and forages. They have clearly never seen food before. One would think they've been starved for 10 years!

 

[LunaticPoodle]

Another update. Went to the vet this morning for an ultrasound, I got a urine sample before that but he pooped at the same time so it was unusable. However the pee was insanely cloudy and there was clearly still blood and a ton of sediment. During the ultrasound he peed right on the table and two more stones came out, and a ton of fragments too. No more stones were visible after that, but of course an empty piggy bladder is virtually impossible to research. The bladder was full of sludge too. We sent the stones to the lab. He's still on Metacam (0.4 ml every 12 hours)- I'd like to increase that a little though, seeing he's still complaining while peeing and his weight is stable- he actually gained back about 15 grams. He's 1.302 grams now.
Vet wants to see him in 2 weeks.
They said I can go ahead with the glucosamine and the guideline given on here was ok (125 mg with Cystease or similar)- my calculations say at least 186mg though with his weight, but I am a disaster at maths and I based myself on dosage for a Syrian Hamster (143mg/kg)...
What do you guys think?

 

[LunaticPoodle]

Hi again everyone, unfortunately just a few weeks of peace since the last stones were peed out. The fresh grass diet seemed to be working so well, last ultrasound showed no stones and greatly reduced sludge, and there were no episodes till 4 days ago where blood came back in full force, and despite Metacam and Cystease has been getting worse, there were even small clots last night in fully bloody pee.

I tested his urine twice last night with strips, they showed very high proteins and obviously blood but otherwise no infection (leukocytes were normal). All other values were normal to low.

No stones came out so far. Got the CBD gel pen from the LAGPR (in case anyone was wondering about customs, Finnish customs let it through without issue), he hates it but if I warm it up between my fingers for a moment he seems more accepting of it.

The vet proposed a medication that will relax his urinary tract making it easier for him to pass stones, and at this point I am willing to try. Surgery seems a bad option since the stones are so stubborn in reforming. I'm afraid he'd just go through it for nothing.
He's been otherwise perky enough, only lost a little weight but not as much as to be worried. He also started to seek comfort by climbing into my shirt, which of course makes me happy for making him feel safe but also sad because he's miserable and in a lot of pain. I'll go get the medication on monday, and watch him like a hawk during Midsummer which is a big holiday here, so husband and me will both be home from work for a few days.
Basically just venting, I guess it takes time for his body to ajdust and balance again. I'm just feeling horrible because he's in pain and I can't make it go away.