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Poorly piggy with bladder stones - to operate or not?

Powerpigs

Powerpigs

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Hi all,

Once again, after a long period of being inactive at the forum, I once again reach out to you all for some advice/support for my poorly piggy Ohmi.

Ohmi is my almost 5 years old neutered boar, who has been a very healthy and happy piggy until recently. On last Thursday I noticed him having difficulties eating and puffing up occasionally. I immediately booked an appointment for my regular piggy savvy vet and started syringe feeding him. Unfortunately I only could get an appointment for yesterday (Monday). Ohmi's condition worsened during the weekend, and what started with occasional puffing up and difficulty eating is now constant puffing up and no desire to eat at all. Yesterday the vet diagnosed him with bladder stones, and anemia/lethargy caused by the pain of them. She encouraged me to try supportive treatments for a couple of days to get him a bit better and ready for the surgery, and we booked a time for tomorrow (Wednesday). Ohmi is now on Metacam, some gut supportive stuff and antibiotics, and they also filled him up with fluids, opioids and vitamins at the clinic yesterday.

What I'm worried about, is there any sense in operating him tomorrow if despite all the supportive care he has been given, I have not been able to encourage him to eat by himself at all, and he has not shown any signs of getting better either. I'm worried if I put him through surgery and then he just would not have the strength to recover from it. The vet also stated the she's not sure if Ohmi will survive the anesthesia in the state he already is, and that's why he wasn't operated immediately in the hopes that the supportive care he's receiving would strengthen him enough to put him through the surgery. The vet also stated yesterday that she would completely understand if I wanted to pts him right away, and said that in her opinion both the surgery and pts are good options, but she still encouraged me to try so that I wouldn't get any regrets later for not trying.

So now I'm seeking for your advice. I know I'm the only one who can make the final call, but what would you do in my shoes? Would you try and operate, or would you gently let the pig go? If anyone has any experience on operating already a poorly piggy and if the piggy made it or not, I would highly appreciate it. In one hand, I'm thinking that maybe the removal of the stones could make him enough pain free that he would start eating again, but then on the other hand he will have more pain because of the surgery, or he won't wake up from anesthesia anyway.
 
Hi and welcome come back!

It is always one of the most difficult decisions you have to make as an owner - and it is only you as the owner who can make that decision. There is no right or wrong; just what you feel in your gut is best for poor Ohmi and for you, and what you can live with best in the long term.
Please take the time to read this link here. It doesn't make the easiest reading but it tackles all the issues that come with end of life decisions and talks you through the various aspects.
A Practical and Sensitive Guide to Dying, Terminal Illness and Euthanasia in Guinea Pigs

A compromise option would be to give your vet permission to not continue with the operation and to no wake up Ohmi if it is not a straight forward bladder stone removal but if the stone or too many crystals have become embedded in the bladder wall or if the stone has fetched up in the awkward inglenook that boars have in their urethra and especially it it has embedded there - the latter can be the end of the road for boars of any age, depending on the extent of the damage and whether it can be removed easily or not; especially with vets not much used to operating on very small animals. Your vet may need to give you a call to ask for your permission to not proceed any further and to not wake Ohmi up if the findings are not good.

I feel for you. Please read the link and see how you stand on this. Listen to your gut as that is how you will feel in the long term. 5 years is the bottom end of the average life span so Ohmi has reached a decent age, whatever happens.

PS: My Ceri has made it through an emergency bladder stone up aged 4 years and at only 540g (after losing 700g in a very short space of time; most just over the weekend before the op on Monday).
And my 5 years old Teggy went through a rather tricky op removing a large wedged in stone in her urethra in October 2020 by my local vet which had started to block the flow of urine by the time we got her in as an emergency. She's still with me.
But it all depends on the condition of Ohmi, the location of the stone and the confidence/assessment of your vet.

HUGS
 
First, I am so sorry you are going through this. :( You are doing everything you can, and it is not an easy decision to make.

Personally, since I have dealt with a few pigs with bloat/gastric issues, I would be afraid the surgery would stress & as he is already almost 5 years old, it may be a lot for his body to go through. It is a risk. However, it is truly your decision & no matter what decision you make, know that it was the best one for you and him - go with your gut on this one. Hugs to you in this difficult time. Please keep us updated as well.
 
Lovely to see you again, but sorry about Ohmi.
My suggestion would be that you make a decision and then live with it for a while.
If it feels right then act, if not then make a different decision.
It’s how I deal with difficult decisions and it helps me feel comfortable when it’s made.
Holding you in my thoughts
 
Thank you all for your replies, you have given me very valuable points and thoughts to consider.

Yesterday, Ohmi was so poorly that I was already leaning towards pts and not trying the surgery. But then in the evening he showed the tiniest amount of getting better, and that has continued today morning. He is still not eating himself, but accepted a slice of cucumber into his mouth and then dropping it, so he has shown a tiny bit of interest toward food at least. (Did not even do this for a couple of days before.) He is still hunching and hiding, but seems a bit more alert than yesterday, and I have also noticed him strolling around a bit. His poops are also getting better, now looking quite normal actually, when during the weekend he was only producing soft, diarrhea like stuff. He also seemed to chew and swallow better when I was syringe feeding him, but still the feeding is clearly making him tired. Thank goodness for remote working, so I'm able to feed him small amounts more often during the day!

To conclude, I think this slight improvement in his condition is making me to change my mind and opting to try the surgery after all. I will of course go through all the options with my vet at today's appointment and hear her assessment. I'm fully aware that the vet might still refuse to operate if she considers Ohmi too weak for anesthesia, and I would be ok with this option. I'm also ok if we try the op, but during the op the vet finds something that makes it unreasonable to continue, this we already discussed on Monday's appointment. It's also ok for me if we do the op, but Ohmi just would not wake up from it after all. What I'm most afraid of, if he makes it through the op, but would not make through the post op care and I would end up with pts after putting him through surgery. This is the only option I'm not ok with. But then again, if there is a chance for him to survive the op and the post op care, and then be able to live his full life whatever time he has left, I feel I'd like to give him that chance. The appointment is at 5.50 pm (Finnish time), so at least I have all day to monitor his condition and to weight all the options in my head.
 
An update, Ohmi just accepted a piece of lettuce (a very rare treat at out house) and actually managed to eat a bit of it! So maybe he is up to trying the surgery...
 
Powerpigs said:
Thank you all for your replies, you have given me very valuable points and thoughts to consider.

Yesterday, Ohmi was so poorly that I was already leaning towards pts and not trying the surgery. But then in the evening he showed the tiniest amount of getting better, and that has continued today morning. He is still not eating himself, but accepted a slice of cucumber into his mouth and then dropping it, so he has shown a tiny bit of interest toward food at least. (Did not even do this for a couple of days before.) He is still hunching and hiding, but seems a bit more alert than yesterday, and I have also noticed him strolling around a bit. His poops are also getting better, now looking quite normal actually, when during the weekend he was only producing soft, diarrhea like stuff. He also seemed to chew and swallow better when I was syringe feeding him, but still the feeding is clearly making him tired. Thank goodness for remote working, so I'm able to feed him small amounts more often during the day!

To conclude, I think this slight improvement in his condition is making me to change my mind and opting to try the surgery after all. I will of course go through all the options with my vet at today's appointment and hear her assessment. I'm fully aware that the vet might still refuse to operate if she considers Ohmi too weak for anesthesia, and I would be ok with this option. I'm also ok if we try the op, but during the op the vet finds something that makes it unreasonable to continue, this we already discussed on Monday's appointment. It's also ok for me if we do the op, but Ohmi just would not wake up from it after all. What I'm most afraid of, if he makes it through the op, but would not make through the post op care and I would end up with pts after putting him through surgery. This is the only option I'm not ok with. But then again, if there is a chance for him to survive the op and the post op care, and then be able to live his full life whatever time he has left, I feel I'd like to give him that chance. The appointment is at 5.50 pm (Finnish time), so at least I have all day to monitor his condition and to weight all the options in my head.
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Unfortunately, any decision is about operation is always in the end a leap of faith since we cannot peer into the future. It always comes down to the decision between whether you buy a ticket for the rollercoaster in the hope that your piggy will come off it with more life time in good quality (but a good chance it may not come off at any point) or whether you want to play it safe with end of life care and all its own emotional ups and downs.

There is sadly no 'safe' solution. I have done it either way with various piggies of mine; neither way is easier or emotionally less taxing. :(

Seeing Ohmi's state, it may be likely that his stone may be located in the urethra.

HUGS
 
Wiebke said:
Unfortunately, any decision is about operation is always in the end a leap of faith since we cannot peer into the future. It always comes down to the decision between whether you buy a ticket for the rollercoaster in the hope that your piggy will come off it with more life time in good quality (but a good chance it may not come off at any point) or whether you want to play it safe with end of life care and all its own emotional ups and downs.

There is sadly no 'safe' solution. I have done it either way with various piggies of mine; neither way is easier or emotionally less taxing. :(

Seeing Ohmi's state, it may be likely that his stone may be located in the urethra.

HUGS
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Thank you Wiebke! Could you please be kind and clarify as I'm not so familiar with this vocabulary in english, but a stone in the urethra is worse than a stone in the bladder, right? The vet didn't specify where the stones are, the x-ray just showed 2-3 large stones (not sure if an x-ray even can specify the location of stones?). Ohmi is still passing pee an not whining while peeing, also no visible blood. They did a stick test at the clinic which showed +1 for blood (in a scale of 0 to +4) and also additional proteins. At first they didn't even consider stones, but after taking the urine sample with some manual therapy, Ohmi passed some red pee and they decided to take an x-ray to check for stones.
 
Powerpigs said:
Thank you Wiebke! Could you please be kind and clarify as I'm not so familiar with this vocabulary in english, but a stone in the urethra is worse than a stone in the bladder, right? The vet didn't specify where the stones are, the x-ray just showed 2-3 large stones (not sure if an x-ray even can specify the location of stones?). Ohmi is still passing pee an not whining while peeing, also no visible blood. They did a stick test at the clinic which showed +1 for blood (in a scale of 0 to +4) and also additional proteins. At first they didn't even consider stones, but after taking the urine sample with some manual therapy, Ohmi passed some red pee and they decided to take an x-ray to check for stones.
Click to expand...
A stone in the urethra can be worse than stones in the bladder (particularly in males) as they are harder to reach, and can cause a total blockage.
If they are very small they can sometimes be passed.
An x-ray will give a good idea about the location of the stones, but the only real way to know exactly what is going on is via surgery.
Once inside the bladder they can see exactly what the state of the walls is like, and also the type of stones and the damage (if any) they they have caused.

Sorry you are going through this - I know that whatever decision you make will be the right one for your Ohmi.
 
My thoughts and well wishes go out to you and Ohmi. I’m so sorry for what you are going through
 
Swissgreys said:
A stone in the urethra can be worse than stones in the bladder (particularly in males) as they are harder to reach, and can cause a total blockage.
If they are very small they can sometimes be passed.
An x-ray will give a good idea about the location of the stones, but the only real way to know exactly what is going on is via surgery.
Once inside the bladder they can see exactly what the state of the walls is like, and also the type of stones and the damage (if any) they they have caused.

Sorry you are going through this - I know that whatever decision you make will be the right one for your Ohmi.
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Thank you Swissgreys for the clarification! If we do decide to try the surgery, I'm asking the vet to notify me if the surgery seems too complicated because of the location of the stones, or if the damage seems too severe, then I would ask her to not continue with the op. Not going to put Ohmi through a tricky surgery, I'm only allowing the vet to proceed if the stones seem easy to remove and no or only manageable damage is seen. I'm trusting my vet to be completely honest with me, and I trust her to say if the op is a no-go from the start, i.e. if Ohmi is in a state that she would not be comfortable operating him at all.
 
Powerpigs said:
Thank you Wiebke! Could you please be kind and clarify as I'm not so familiar with this vocabulary in english, but a stone in the urethra is worse than a stone in the bladder, right? The vet didn't specify where the stones are, the x-ray just showed 2-3 large stones (not sure if an x-ray even can specify the location of stones?). Ohmi is still passing pee an not whining while peeing, also no visible blood. They did a stick test at the clinic which showed +1 for blood (in a scale of 0 to +4) and also additional proteins. At first they didn't even consider stones, but after taking the urine sample with some manual therapy, Ohmi passed some red pee and they decided to take an x-ray to check for stones.
Click to expand...
The urethra is the tube leading from the bladder to the exit. Any stones that are washed out of the bladder into the urethra in boars are usually not good news. If they are inside the bladder, then it is a much easier operation.
A practised vet should be able to see on an x-ray whether the stones are still in the bladder area or have moved toward the back of the body - especially when they are lined up like beads on a string. what the x-ray cannot tell is any damage to the walls of the urinary tract ('bladder trauma').

Here is a picture of Teggy's massive urethral stone x-ray in October 2020 (urethral sow stones tend to fetch up just befor the exit, held in by a ring of muscles that control the peeing). The bladder is roughly in the area between the yellow blobs in front of the back legs.

Teggy, urethral stone x-ray 2020.webp
 
Wiebke said:
The urethra is the tube leading from the bladder to the exit. Any stones that are washed out of the bladder into the urethra in boars are usually not good news. If they are inside the bladder, then it is a much easier operation.
A practised vet should be able to see on an x-ray whether the stones are still in the bladder area or have moved toward the back of the body - especially when they are lined up like beads on a string.
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Thank you Wiebke for the clarification, now I got it! I'm not sure why the vet didn't say anything about the location, and I didn't know to ask. I don't know if it was harder for her to say, because the x-ray was taken while Ohmi was full conscious. At least what I remember (don't have the x-ray with me) the stones were not lined up, but rather grouped together. But they did seem to be at the back of the body, somewhere in the pelvis region but quite high up considering where the exit is.
 
Has he been xrayed and are the stones in his bladder. It's important to have the stones removed before they reach his urethra. We have had piggies up to 5.5 years survive this op. It is important that you have a vet that has done this op several times successfully
 
Wiebke said:
The urethra is the tube leading from the bladder to the exit. Any stones that are washed out of the bladder into the urethra in boars are usually not good news. If they are inside the bladder, then it is a much easier operation.
A practised vet should be able to see on an x-ray whether the stones are still in the bladder area or have moved toward the back of the body - especially when they are lined up like beads on a string. what the x-ray cannot tell is any damage to the walls of the urinary tract ('bladder trauma').

Here is a picture of Teggy's massive urethral stone x-ray in October 2020 (urethral sow stones tend to fetch up just befor the exit, held in by a ring of muscles that control the peeing). The bladder is roughly in the area between the yellow blobs in front of the back legs.

View attachment 196878
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When I first quoted you Wiebke I was not seeing the example x-ray you provided. Thank you for this picture! But if my memory serves me right, the stones were indeed somewhere around the the bladder area, not as low and near the bum as in here. Also I would guesstimate the size of them slightly smaller than in this picture.

Stewybus said:
Has he been xrayed and are the stones in his bladder. It's important to have the stones removed before they reach his urethra. We have had piggies up to 5.5 years survive this op. It is important that you have a vet that has done this op several times successfully
Click to expand...
He has been x-rayed, but unfortunately I don't have the file to show you guys as I didn't receive a copy. For some reason my vet didn't say anything about the location of the stones and I didn't understand to ask about it. It is very nice to hear that you have had older piggies going through this op before. May I ask in what condition were the before the op? The thing that worries me most is putting an already poorly piggy to surgery. My vet is one of the most experienced ones you can get here in Finland for piggies, and I know she has done this op several times before, and she said the op itself will not be a problem for her if there isn't any fatal finding after opening Ohmi up. This vet is the same one who has done Ohmi's neutering and at least back then everything went perfectly.
 
(((Hugs))) it’s a tough decision to make where there is no correct answer. I guess you have to weigh up the pros and cons of each option but if it were one of my piggies, I think I would be inclined to go with the surgery as if you don’t, he will die anyway whether that be pts or if he doesn’t survive the surgery and I would want to give him a chance. But as I have already mentioned, it’s a tough decision to make and whichever choice you make will be the right one for you and your boy x
 
Powerpigs said:
When I first quoted you Wiebke I was not seeing the example x-ray you provided. Thank you for this picture! But if my memory serves me right, the stones were indeed somewhere around the the bladder area, not as low and near the bum as in here. Also I would guesstimate the size of them slightly smaller than in this picture.


He has been x-rayed, but unfortunately I don't have the file to show you guys as I didn't receive a copy. For some reason my vet didn't say anything about the location of the stones and I didn't understand to ask about it. It is very nice to hear that you have had older piggies going through this op before. May I ask in what condition were the before the op? The thing that worries me most is putting an already poorly piggy to surgery. My vet is one of the most experienced ones you can get here in Finland for piggies, and I know she has done this op several times before, and she said the op itself will not be a problem for her if there isn't any fatal finding after opening Ohmi up. This vet is the same one who has done Ohmi's neutering and at least back then everything went perfectly.
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That is a private picture my vet sent me after Teggy's op so you wouldn't have likely come across it when searching. And that is about as large a urethral stone as you will ever see! How it got as far down without blocking the urethra is anybody's guess. :(
 
Okay, the decision has been made and Ohmi's surgery is about to start! The vet agreed that Ohmi has perked up and agreed with me that we should give him a chance and that he is in a condition that the chance can be given. Keeping everything crossed and hoping I won't get an early phone call from the vet, she promised to call if anything came up during the op.
 
Powerpigs said:
Okay, the decision has been made and Ohmi's surgery is about to start! The vet agreed that Ohmi has perked up and agreed with me that we should give him a chance and that he is in a condition that the chance can be given. Keeping everything crossed and hoping I won't get an early phone call from the vet, she promised to call if anything came up during the op.
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All fingers firmly crossed for Ohmi!
 
We are here for you whatever happens. Good luck. You’re a great piggie mum ❤️
 
Hope the surgery goes well and Ohmi makes a full recovery.
I’m sure that he will receive excellent care from you.
There is some very helpful advice on caring for a post op piggy here but I lack the tech skills to link it for you.
 
Ok, so I have good news and bad-ish news. The good news is that Ohmi made through the surgery well and is now a bit sleepy but woken up. The bad-ish news is that there were no stones to be removed. The vet opened him up but there were no stones to be seen, all his organs were perfectly fine and the insides of his bladder looked perfectly ok. She flushed the bladder just in case and took another x-ray to be sure, mut the so called stones that were clearly visible on monday's picture were now completely gone! At this point she called me and asked my opinion on whether to wake him up or not. The vet felt that because Ohmi was already perking up a bit before the op, we should give him a chance to get better still as she could find nothing wrong with him. I agreed to this, and now the deal is to see what happens during this week, and if no signs of getting better then calling the quits. The vet's best bet was that whatever Ohmi had was already recovering due to the antibiotics and Metacam he has been given, and now I will continue with those plus Primperan for his tummy.

I'm a bit baffled and sorry to have put Ohmi through what now seems an unnecessary op, but I was happy with my decision to try the op so I will need to stick with that now.
 
I am so pleased that Ohmi has woken up from his surgery. I guess he could have passed the stones? Don't feel bad. A long time ago I had a pig with chronic bladder problems. The x ray showed something in her bladder (could have been stones or tumours) and I agreed for the vet to open her up. When she was opened up, all the vet found was bladder sludge so she had a bladder flush. Sadly, we lost her several days later but without the surgery, I was faced with having her pts without knowing exactly what was wrong with her x
 
Hmm, maybe he did pass the stones? Awww...I am glad he has woken up from the surgery. Go easy on yourself, you wouldn't have had any way to know the findings.
I hope he makes a good recovery, please keep us posted on mr. Ohmi.
 
At least the vet said that there is no way a boar could have had passed stones, and the things we saw on Monday's x-ray were diagnosed to be large ones. But at least there's nothing in there now, I can only hope for the meds to work their magic.
 
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