Specialist IC with arthritis? Help needed.

[Leilalouise]

My 5ish year old Siobhan has been back & fore to the vet since she was spayed for ovarian cysts in June. She’s had recurring episodes of soft/runny poos and the odd squeaky wee with strong-smelling urine. Initial thought was abdominal inflammation post-surgery and she was treated with Metacam. This helped but once it was stopped the symptoms returned. She was then given a week of Baytril after a urine dipstick showed trace of blood and a second week of Baytril was given when the blood trace was still present on re-test. A urine sample was sent off which showed no bacteria but 3+ blood. Due to this result and the fact that symptoms were still present she then had an ultrasound which showed no stones or growths but vet admitted that it wasn’t possible to be certain of no adhesions as it was very difficult to visualise these on ultrasound. She has been continued on Metacam since the scan but whenever we try to wean this, the runny poos and squeaky wees recur. She was also started on Cystease about 10 days ago. Another urine sample was dipsticked last week and again showed blood despite the Metacam and Cystease. The sample was therefore sent off and at vets this morning the result showed 3+ blood, no bacterial growth and signs of crystals but also very oddly traces of antibiotic! Now Siobhan hasn’t been on an antibiotic since June/July and the vet did discuss with me that it is possible that some animals do self-produce but this isn’t common. Obviously the finding of crystals is good as we now know the cause of her urinary symptoms but we are baffled as to why the presence of crystals is affecting her digestion to the extent of cow-pat poos. Does anyone have any suggestions? Also can anyone shed any light on the presence of antibiotic when none should be present? For the moment she’s staying on Metacam 0.2 ml twice daily and Cystease but vet is reluctant to keep her on Metacam long-term. Any advice/suggestions welcome. Thanks x

 

[Leilalouise]

So sorry for the length of my post!

 

[Wiebke]

My 5ish year old Siobhan has been back & fore to the vet since she was spayed for ovarian cysts in June. She’s had recurring episodes of soft/runny poos and the odd squeaky wee with strong-smelling urine. Initial thought was abdominal inflammation post-surgery and she was treated with Metacam. This helped but once it was stopped the symptoms returned. She was then given a week of Baytril after a urine dipstick showed trace of blood and a second week of Baytril was given when the blood trace was still present on re-test. A urine sample was sent off which showed no bacteria but 3+ blood. Due to this result and the fact that symptoms were still present she then had an ultrasound which showed no stones or growths but vet admitted that it wasn’t possible to be certain of no adhesions as it was very difficult to visualise these on ultrasound. She has been continued on Metacam since the scan but whenever we try to wean this, the runny poos and squeaky wees recur. She was also started on Cystease about 10 days ago. Another urine sample was dipsticked last week and again showed blood despite the Metacam and Cystease. The sample was therefore sent off and at vets this morning the result showed 3+ blood, no bacterial growth and signs of crystals but also very oddly traces of antibiotic! Now Siobhan hasn’t been on an antibiotic since June/July and the vet did discuss with me that it is possible that some animals do self-produce but this isn’t common. Obviously the finding of crystals is good as we now know the cause of her urinary symptoms but we are baffled as to why the presence of crystals is affecting her digestion to the extent of cow-pat poos. Does anyone have any suggestions? Also can anyone shed any light on the presence of antibiotic when none should be present? For the moment she’s staying on Metacam 0.2 ml twice daily and Cystease but vet is reluctant to keep her on Metacam long-term. Any advice/suggestions welcome. Thanks x

Hi!

There is a condition called sterile interstitial cystitis which has become much more common especially in indoors guinea pigs over the last decade that is unfortunately not well know outside vet circles seeing guinea pigs on a regular basis. It is called sterile (i.e. non-bacterial) interstitial (i.e. chronic with regular flare-ups) cystitis (bladder infection) or sterile IC. This means that it doesn't react to antibiotics and is usually diagnosed only by default after all other problems in the urinary tract have been excluded. It cannot be healed, only managed until it eventually goes away on its own - but usually more in a matter of years rather than months.

Treatment is similar to that of cats who are the other species with sterile cystitis, mainly by glucosamine (the contents of 1 capsule of cystease mixed with 2 ml of water; give 1 ml every 12 hours) and metacam to deal with the inflammation. Sometimes potassium citrate is also prescribed.
You can find our diet recommendations for IC piggies in the chapter for piggies with urinary tract problems; depending on the severity of the sterile IC some piggies can have individual trigger foods, which cause increased smelly urination. But a low calcium, grain-free, high sugar/root free veg and pellet diet can help with removing the most common trigger foods and help to stabilise your piggy outside of the flare-ups, which should hopefully lengthen in interval as time goes by.
Long Term Balanced General And Special Needs Guinea Pig Diets

The good news is that while IC is definitely not pleasant, it doesn't impact on the life span and it doesn't cause any bladder stones. Once it is fully gone, it won't come back. My Nerys had three years with IC floolowed by three more years totally free of any bladder problems and died at the ripe old age of 8 years in 2016.

Please accept that it can take a goodly while (i.e. several weeks) until acute symptoms are settling down and that you will see a sudden flare up every few weeks. Glucosamine and metacam take a while to build up; you are in it for the long term.
We haven't seen it used here in the UK yet and don't have therefore any first-hand practical experience with it, but if you have one of the more extreme cases, then monthly cartrofen infection (again, a glucosamine based dog arthritis medication) have been found in recent research to be effective.

Here is more information on sterile interstitial cystitis: Links - Interstitial Cystitis - Guinea Lynx Records

 

[Leilalouise]

Thanks @Wiebke for your reply, that’s really helpful info. Also good to know we’re doing the right thing, just going to take a while. I was getting a tad frustrated that we didn’t seem to be getting anywhere in all these months. I’ll definitely discuss IC with the vet when we go back in a couple of weeks. Luckily, he is very used to me & my pigs by now, I’ve been seeing him for the past 20 years so we have very good piggie discussions! Thanks again x

 

[Leilalouise]

Apologies, just wanted to check a few things.

1. Metacam dose-vet originally gave 0.2 ml once daily but because of metabolism I requested twice daily (so total of 0.4 ml daily). Now reading back through some other threads it’s recommended to split the dose rather than double so I may have misunderstood. Should I be giving 0.1 ml twice daily to make 0.2 daily dose or am I OK to continue with 0.2 twice daily? Am going through a lot of Metacam with both girls on it long-term.

2. I’ve changed the girls’ diet to the veggies sample plate tweaked for IC (my other pig Sinead has a bladder tumour so they were both on grain-free pellets & semi-modified diet anyway) but they both hate pepper and won’t touch it! I have looked at the list of alternatives but can’t seem to work out which I can safely substitute & the IC diet recommends no tweaks. Suggestions?

3. Siobhan still has occasional soft poos despite 24 hours of no veggies and masses of hay. Weight stable though and she’s fine in herself. Could this be due to the general irritation of IC?

4. Anyone else had the presence of antibiotic show up in a urine sample when not on any? Just interested.

Thanks again x

 

[Wiebke]

Apologies, just wanted to check a few things.

1. Metacam dose-vet originally gave 0.2 ml once daily but because of metabolism I requested twice daily (so total of 0.4 ml daily). Now reading back through some other threads it’s recommended to split the dose rather than double so I may have misunderstood. Should I be giving 0.1 ml twice daily to make 0.2 daily dose or am I OK to continue with 0.2 twice daily? Am going through a lot of Metacam with both girls on it long-term.

2. I’ve changed the girls’ diet to the veggies sample plate tweaked for IC (my other pig Sinead has a bladder tumour so they were both on grain-free pellets & semi-modified diet anyway) but they both hate pepper and won’t touch it! I have looked at the list of alternatives but can’t seem to work out which I can safely substitute & the IC diet recommends no tweaks. Suggestions?

3. Siobhan still has occasional soft poos despite 24 hours of no veggies and masses of hay. Weight stable though and she’s fine in herself. Could this be due to the general irritation of IC?

4. Anyone else had the presence of antibiotic show up in a urine sample when not on any? Just interested.

Thanks again x

Hi!

1. Which metacam are you using? Dog or cat metacam. Dog metacam is three times the strength of cat metacam. It makes a big difference.
You can safely double the current metacam dosage even if it is dog metacam (your vet is rather conservative) until you get the IC under control and then up the dosage to higher whenever you have an acute flare up but lower it during the quiet periods; you will hopefully eventually get a feel for how much it takes to keep your piggy stable over the longer term.
I would also see whether a higher dose of metacam can help with the soft poos in case they are caused by pain in the irritated bladder.

2. If your girls don't like pepper, replace the pepper with feeding more coriander or - provided that fresh grass is not a trigger food, as it can be with some piggies - with a handful of that; please don't feed damp grass as that can cause diarrhea. Grass is actually high in vitamin C and hay contains it, too (which is the reason why guinea pigs have never had the need to make their own vitamin C in the first place; their main food source is providing plenty!)
Alternatively feed a small amount of kale instead of greens 2-3 times a week. Greens are the same family as kale but not as high in vitamin C and calcium.

3. Try poo soup and see whether transferring healthy live gut microbiome can help with the soft poo issue so you make a two-pronged approach on this issue. Long term antibiotics can also mess with gut microbiome. Pain in the urinary or reproductive tract can also impact on the gut as they are all very closely backed together.

I hope that that helps you? Good that you have a good relationship with your vet; it is important. I am also happy that my local general vets have come to trust my piggy knowledge. They know I am only asking for things that have been prescribed successfully by exotics vets and that I know from the forum do really work. I am always respectful of their judgment and training, however. For operations and specialist issues I use another specialist vet further abroad if possible.

 

[Leilalouise]

Hi again Wiebke

1. Apologies, I forgot to say-it’s dog Metacam. OK, I will give my vet a call and request a dose increase up to 0.4 ml twice daily (total dose 0.8 ml).

2. I have some grass growing in trays so I will replace the pepper with that in the first instance & keep an eye.

3. Siobhan has horrendous cow pats again this morning, necessitating a bum bath but her weight is still the same. She hasn’t had veggies for more than 48 hours now so I will try the poo soup once more. Otherwise hopefully the increased Metacam will help.

Thanks for all the advice, that’s really helpful. My vet is great, there are two I see at the practice (Graham Blow and Barrie Williams at Bridge Veterinary Centre, Pontllanfraith, if you want to add them to the list of recommended) and, like your vet, they respect my opinion and we discuss their recommendations before deciding on treatment. They obtained a copy of the Lance Jepson Exotic Medicine book at my suggestion and in the past have telephoned Simon Maddock on several occasions for advice when I had a severe dental pig, so I think we have a good relationship. Plus the advice I get on here and from Suzy at GGPR, where my girls came from, is invaluable. Thanks again. x

 

[Leilalouise]

Hi @Wiebke,
Thought I’d post an update. We’ve been slowly on the up with Siobhan since making the dietary changes along with Cystease & increased Metacam and after several weeks with good poops and stable weight we’ve now reached the point where we are assuming a diagnosis of IC and vet is happy for me just to continue monitoring and tweak medications as needed with vet visits only if required. Yay! So thanks for all your help and advice.

On another note, my other pig Sinead had a diagnosis of a bladder tumour and when her squeaky wees recently recurred despite Metacam we went to the vet all prepared for the ‘Rainbow bridge discussion’. Surprise surprise, repeat scan showed no evidence of tumour, despite definite abnormality on previous scan! Vet at a loss to explain that one but as Sinead has definite urinary symptoms we are treating her as IC too. What are the odds?!

Lovely vet offered me a prescription for a 180 ml bottle of Metacam as I now have two girls in it long-term and advised me to order online to save myself up to £80. Honestly, my vets are the best. Here’s a pic of the bottle with Siobhan as size reference-should keep me going for a while

PS. Could an admin please change the title of my post to reflect IC? Might be of some use to others in that respect. Cheers x

 

[Leilalouise]

I need some more help on this one please. Sinead & Siobhan were back at vets again this week as Sinead continues to have terrible squeaky wees and Siobhan still has blood in her urine. Both pigs urine samples contained blood but no bacteria and Sinead's sample also showed signs of calcium crystals. Therefore both pigs had yet another set of ultrasound scans and also x-rays. These tests showed that Sinead has a thickened bladder wall and maybe some sludge but not enough for bladder flush but no stones/tumours. Siobhan had better scans from the point of view of her bladder but hers also revealed arthritic back legs. So vet thinks we are dealing with a chronic cystitis (IC) in both pigs and Siobhan has painful arthritis with the pain possibly transmitted to the bowel, resulting in the loose poops that she has every so often.

Anyway both vet and I are stumped now as to next steps. Diet changes suggested to help Siobhan's arthritis are contraindicated in a pig with bladder sludge. Bladder/IC wise, I am already doing everything recommended and both pigs still have symptoms. Both pigs are on 0.3 ml of dog Metacam twice daily along with a vegan liquid glucosamine supplement mixed with water (which equates to roughly the same dose of Cystease 1 capsule in 2 ml of water). They have Science Selective grain-free nuggets (Sinead has 1 tablespoon, Siobhan has 2 as she has gradually become really skinny), unlimited copious amounts of meadow hay (Haybox) along with timothy hay and daily veggies as directed by the IC sample plate, although I give 2-3 sprigs of coriander in place of pepper as neither pig will touch pepper. Vet has suggested increased vitamin C to raise the pH level of the urine and also possibly help with Siobhan's arthritis but I'm not sure how to do this. I have some Pro-C professional which I am giving but I'm not sure whether they can stay on this long-term - the tub mentions 'general support' but I don't know if this means indefinite. Can anyone help with this or any other suggestions?

All advice gratefully received.

Thanks x

 

[Leilalouise]

Hi @sport_billy / @BossHogg. Is there any way you could please change the title of this thread for me to reflect IC with arthritis? I could really do with some advice on managing this. I posted but haven’t had any replies yet and I think the title is now misleading. Thanks v much x

 

[BossHogg]

Will that do?

 

[Leilalouise]

@BossHogg That’s marvellous. Thank you. x

 

[Piggies&buns]

This isn’t something I have experience of so I will tag in @Wiebke

 

[Wiebke]

I need some more help on this one please. Sinead & Siobhan were back at vets again this week as Sinead continues to have terrible squeaky wees and Siobhan still has blood in her urine. Both pigs urine samples contained blood but no bacteria and Sinead's sample also showed signs of calcium crystals. Therefore both pigs had yet another set of ultrasound scans and also x-rays. These tests showed that Sinead has a thickened bladder wall and maybe some sludge but not enough for bladder flush but no stones/tumours. Siobhan had better scans from the point of view of her bladder but hers also revealed arthritic back legs. So vet thinks we are dealing with a chronic cystitis (IC) in both pigs and Siobhan has painful arthritis with the pain possibly transmitted to the bowel, resulting in the loose poops that she has every so often.

Anyway both vet and I are stumped now as to next steps. Diet changes suggested to help Siobhan's arthritis are contraindicated in a pig with bladder sludge. Bladder/IC wise, I am already doing everything recommended and both pigs still have symptoms. Both pigs are on 0.3 ml of dog Metacam twice daily along with a vegan liquid glucosamine supplement mixed with water (which equates to roughly the same dose of Cystease 1 capsule in 2 ml of water). They have Science Selective grain-free nuggets (Sinead has 1 tablespoon, Siobhan has 2 as she has gradually become really skinny), unlimited copious amounts of meadow hay (Haybox) along with timothy hay and daily veggies as directed by the IC sample plate, although I give 2-3 sprigs of coriander in place of pepper as neither pig will touch pepper. Vet has suggested increased vitamin C to raise the pH level of the urine and also possibly help with Siobhan's arthritis but I'm not sure how to do this. I have some Pro-C professional which I am giving but I'm not sure whether they can stay on this long-term - the tub mentions 'general support' but I don't know if this means indefinite. Can anyone help with this or any other suggestions?

All advice gratefully received.

Thanks x

Hi!

Glucosamine seems to be the key treatment in sterile IC - and thankfully also arthritis. If symptoms are persistent and severe, would your vet be willing to look into cartrofen injections? This is a glucosamine based arthritis drug that has been recently successfully trialled in use for sterile IC in both cats and guinea pigs, the two species prone to it.

As this is still very new and only just in the process of being taken up and tried by UK vets, there is not any established guidance on frequency etc.
We have so far had a forum member with fortnightly injections and one with monthly (use the search option on the top bar for 'cartrofen'). But especially in your situation, it might be the ideal treatment for addressing both issues at the same time. Metacam also works for both issues.

For the bladder sludge, could you try to offer your piggy twice daily water from the syringe, as much as it is taking willingly in one session (please never force any down) to encourage a couple of bigger pees that help flush the bladder and minimise a further build-up?
You can give pro-C for the longer term but as it contains glucose (sugar), I would check with your treating vet if you have any concerns.

 

[Leilalouise]

Hi!

Glucosamine seems to be the key treatment in sterile IC - and thankfully also arthritis. If symptoms are persistent and severe, would your vet be willing to look into cartrofen injections? This is a glucosamine based arthritis drug that has been recently successfully trialled in use for sterile IC in both cats and guinea pigs, the two species prone to it.

As this is still very new and only just in the process of being taken up and tried by UK vets, there is not any established guidance on frequency etc.
We have so far had a forum member with fortnightly injections and one with monthly (use the search option on the top bar for 'cartrofen'). But especially in your situation, it might be the ideal treatment for addressing both issues at the same time. Metacam also works for both issues.

For the bladder sludge, could you try to offer your piggy twice daily water from the syringe, as much as it is taking willingly in one session (please never force any down) to encourage a couple of bigger pees that help flush the bladder and minimise a further build-up?
You can give pro-C for the longer term but as it contains glucose (sugar), I would check with your treating vet if you have any concerns.

Thanks for the helpful advice once more. I’ll continue with the Glucosamine and Metacam at the same doses and increase the water offered. Luckily both pigs willingly take syringed fluid so shouldn’t be too arduous a task. I’ll try this for a few days, maybe a week and see if I get a favourable response. If not, I’ll go back to vet and discuss the option of Cartrofen. I don’t mind doing whatever is needed as long as there’s a chance it will help my girls- it’s been awful watching them and Sinead’s squeaky wees are truly heartbreaking. I’ll keep you posted. Thanks again. x

 

[Leilalouise]

Update on this one - I’ve been syringing roughly 7ml of water twice a day per pig since Monday. Siobhan loves it and although Sinead is less keen on the last few she takes it easily with the end of the syringe dipped in the strawberry glucosamine liquid to fool her into thinking it’s more tasty than water We are now day four into this regime and I have only noted one single squeaky wee from Sinead, and she usually shrieks the place down every time. Similarly I’ve not seen any blood from Siobhan and her bits look nice and clean. I know it’s still early days but I’m hopeful this is the start of the up. x

 

[Wiebke]

Update on this one - I’ve been syringing roughly 7ml of water twice a day per pig since Monday. Siobhan loves it and although Sinead is less keen on the last few she takes it easily with the end of the syringe dipped in the strawberry glucosamine liquid to fool her into thinking it’s more tasty than water We are now day four into this regime and I have only noted one single squeaky wee from Sinead, and she usually shrieks the place down every time. Similarly I’ve not seen any blood from Siobhan and her bits look nice and clean. I know it’s still early days but I’m hopeful this is the start of the up. x

I am glad that things are looking up. Please be aware that the 'I' in IC is standing for interstitial, which unfortunately means recurring flare-ups every few weeks or months. I would stay off the high metacam dose during the times when the IC is not causing any problems and then switch to the higher dosage during flare-ups. Depending on the arthritis, you may have to gradually up the long term dosage, too. Soft poos can be a result of pain, both from the IC or the arthritis.

 

[gigspinny]

Update on this one - I’ve been syringing roughly 7ml of water twice a day per pig since Monday. Siobhan loves it and although Sinead is less keen on the last few she takes it easily with the end of the syringe dipped in the strawberry glucosamine liquid to fool her into thinking it’s more tasty than water We are now day four into this regime and I have only noted one single squeaky wee from Sinead, and she usually shrieks the place down every time. Similarly I’ve not seen any blood from Siobhan and her bits look nice and clean. I know it’s still early days but I’m hopeful this is the start of the up. x

Is that the
Healthspan 1000mg liquid? How much do you give? I was trying to work out what the vegan glucosamine equivalent would be as the type (Cystease use N-Acetyl vs vegan HCI) and a absorption are said to be different, sounds tasty though!

 

[Leilalouise]

I am glad that things are looking up. Please be aware that the 'I' in IC is standing for interstitial, which unfortunately means recurring flare-ups every few weeks or months. I would stay off the high metacam dose during the times when the IC is not causing any problems and then switch to the higher dosage during flare-ups. Depending on the arthritis, you may have to gradually up the long term dosage, too. Soft poos can be a result of pain, both from the IC or the arthritis.

Thanks Wiebke I’ve started to reduce the dose of Metacam over the last two days (from 0.4 ml twice daily to 0.3 ml twice daily) and will continue this measured reduction over the next couple of weeks while continuing the increased water and see what happens symptom-wise with both girls. We’ve definitely got reduced squeaky wees and both girls are holding their weight so I am cautiously optimistic that their current flares might eventually be calming down. At the first sign of an increase in symptoms again though, at least I know the next steps to take. x

 

[Leilalouise]

Is that the
Healthspan 1000mg liquid? How much do you give? I was trying to work out what the vegan glucosamine equivalent would be as the type (Cystease use N-Acetyl vs vegan HCI) and a absorption are said to be different, sounds tasty though!

Hi, yes it is the Healthspan liquid, it’s strawberry flavour and my girls snatch the syringe off me so must taste nice! I was a bit stuck with dose conversion as well but I found a thread (typically I can’t find it again now) that suggested the dose of Glucosamine should be about 150mg per day. So for a glucosamine preparation stating that 10ml of liquid provides 1000mg of Glucosamine, a dose of 1.5ml would equal 150mg of Glucosamine. So because the Healthspan liquid is to be mixed with water, I mix 1.5 ml of Glucosamine with about 15 ml of water and give half of that twice per day. Does that make sense? Probably the water content should be higher but I can’t get my girls to take any more than about 7 ml in one sitting. x

 

[Leilalouise]

Sorry, I don't have any experience with this, but aim for a dosage that contains roughly 150 mg of glucosamine per day.
You can give 0.4 ml (or just below) of loxicom safely twice daily and see whether that is making a difference.

@gigspinny
Found the thread! The quote is from Wiebke, so to be trusted x