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UTI, urine still bloody on antibiotics

Laszlo&Pollen

New Born Pup
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Hello all, I’m looking for help and other ideas for my 1.5-2yo (estimated) boar, Pollen. He underwent light sedation (isofluorane) at the vet on Friday 3/17 for an X-ray to rule out dental issues after about a month of one intermittently runny nostril.

The X-ray was normal, but it took him the whole weekend to bounce back from the sedative - he wasn’t eating well with some weird poops, and wasn’t moving around much, just sleeping in one spot. I noticed his belly was wet and he smelled strongly of ammonia the whole weekend, which made sense given he was just lying in his pee and not drinking as well. He seemed to be having to push a little more than usual to poop as well.

I topped him up with syringe feeds and handfeeding through the weekend, and by Monday 3/20 he was pretty much back to normal behaviorally, with normal quantity of good-shaped poops. I did notice at that time he still seemed to be pushing his poops out with more effort than usual, and an increase in white chalky deposits where his urine had dried at that time (not gritty), more than his norm.

The next morning (Tues 3/21), I found small spots of blood in his urine on his fleece liners. He was otherwise continuing to act normally, other than still putting a little more effort than usual into pushing poops out.

I took him back to the vet Wednesday 3/22 after unsuccessful attempts to collect my own urine sample unfortunately, and explained that due to the timing of everything with lying in his pee and not drinking as well, I was worried for UTI. I got a lot of attitude from the intern vet who insisted the only 2 options were to 1) “Do nothing because some possible blood isn’t really a big deal” or 2) sedate him again for cystocentesis and bloodwork. She refused to attempt a urine sample any other way, even to evaluate for red blood cells, and insisted that it wasn’t him lying in his urine after sedation that had caused this to develop. She did review his X-rays from a few days prior (which were whole-body) and confirmed there was no stone, and begrudgingly agreed to try Bactrim (TMP-SMZ) x 14 days empirically.

Today is day 7 of antibiotic (which he has now decided he no longer likes just to make things more fun), and he is still having spots of blood in his urine, although they’re now more dilute and more often pink than red. He’s still not wheeking or hunching while peeing, and is eating and drinking well with normal poops. I’m giving him Benebac and increasing watery veggies like cucumber, and he’s already on a low-calcium diet with filtered water at baseline.

I just lost my other piggy from postop complications after bladder stone removal in November, which was preceded by months of UTIs/bloody urine, so this just feels like I’m stuck in a nightmare and is bringing it all back. Has anyone experienced continued bloody urine this long into antibiotics? I know about sterile IC but based on the timing of symptom development, I’m more suspicious of UTI at the moment…anyone have any other thoughts?
 
Just an update - now as of last night crying while passing poops and urine. Back to the vet tomorrow.
 
I’m so sorry for all your complications! I’m going through it with one of my piggies atm and it’s so stressful. I had an IC pig who sadly passed away last year so it feels very much like “here we go again!”.

Are there any other vets you can try? I’ve shopped around a lot over 7 years of having piggies and tbh from the service you got I would definitely try another vet! They should just be able to take a sample by manipulating the bladder especially if it is uncomfortable.

Are you supplementing with a probiotic as well? You’ll need it to rebuild the gut flora if you haven’t got any going atm. I tend to use Pro C which they love!

We used Cystease for Iggy’s IC with filtered water and low calcium diet just like you mentioned as well. We also gave him metacam/loxicom for pain and inflammation.

If it is a urine infection perhaps the bacteria present isn’t affected by the baytril so you could try another antibiotic like co-trimoxazole/sulfatrim. Again a urine test would be ideal!

It’s hard isn’t it? I’m in the same boat trying to figure out what it is right now so it’s awful. I hope he’s doing okay! X
 
Thanks so much for your reply!

I thankfully got a different vet at the academic center, which has made a world of difference. He has been on a probiotic (Benebac) the whole time with the TMP/SMZ (Bactrim)! :)

Long story short, Pollen’s urine showed crystals and blood but no bacteria (he’d been on Bactrim for over a week at that point so not surprising). He had an ultrasound which showed flattened sludge in his bladder (the radiologist called it a “roofing tile”) rather than a stone, thankfully. I asked about many things I’ve read about including diuresis with something like HCTZ, glucosamine/Cystease, shilintong/other urinary muscle relaxants, potassium citrate - none of which the vet recommended, as neither she nor her colleagues were super familiar with using (we are in the US). He was started on Metacam with plan to finish 14 days of Bactrim and reassess at that time.

I did also start him on the Sherwood urinary tabs at that time; I don’t believe their claims to dissolve stones, but it was more of a “can’t hurt” thing than anything.

Initially he seemed to be much improved in terms of discomfort. Unfortunately he was still having bloody urine a week after finishing the Bactrim, so was advised to continue the metacam and call back again in 1 week, which brings us to today.

He’s continued with bloody urine including small blood clots, and over the past 2 days increased crying with poops again. It looks as though he’s actually passing some sludge on the fleece liner, so I’m wondering if that is causing his increased discomfort. I’ve been syringing some oral fluids with unflavored Pedialyte, which he’s unimpressed with but reluctantly accepts a bit at a time.

I spoke with the vet again today and she recommended to restart the Bactrim, increase his dose of metacam, add gabapentin for additional pain control, and start subcutaneous fluids to really flush the bladder….and obviously come back for repeat imaging if anything worsens or doesn’t improve.

Thankfully he’s still eating, drinking, and acting normally other than when he poops, but this breaks my heart. I’m so sorry you’re in the same situation!
 
Thanks so much for your reply!

I thankfully got a different vet at the academic center, which has made a world of difference. He has been on a probiotic (Benebac) the whole time with the TMP/SMZ (Bactrim)! :)

Long story short, Pollen’s urine showed crystals and blood but no bacteria (he’d been on Bactrim for over a week at that point so not surprising). He had an ultrasound which showed flattened sludge in his bladder (the radiologist called it a “roofing tile”) rather than a stone, thankfully. I asked about many things I’ve read about including diuresis with something like HCTZ, glucosamine/Cystease, shilintong/other urinary muscle relaxants, potassium citrate - none of which the vet recommended, as neither she nor her colleagues were super familiar with using (we are in the US). He was started on Metacam with plan to finish 14 days of Bactrim and reassess at that time.

I did also start him on the Sherwood urinary tabs at that time; I don’t believe their claims to dissolve stones, but it was more of a “can’t hurt” thing than anything.

Initially he seemed to be much improved in terms of discomfort. Unfortunately he was still having bloody urine a week after finishing the Bactrim, so was advised to continue the metacam and call back again in 1 week, which brings us to today.

He’s continued with bloody urine including small blood clots, and over the past 2 days increased crying with poops again. It looks as though he’s actually passing some sludge on the fleece liner, so I’m wondering if that is causing his increased discomfort. I’ve been syringing some oral fluids with unflavored Pedialyte, which he’s unimpressed with but reluctantly accepts a bit at a time.

I spoke with the vet again today and she recommended to restart the Bactrim, increase his dose of metacam, add gabapentin for additional pain control, and start subcutaneous fluids to really flush the bladder….and obviously come back for repeat imaging if anything worsens or doesn’t improve.

Thankfully he’s still eating, drinking, and acting normally other than when he poops, but this breaks my heart. I’m so sorry you’re in the same situation!

Aw I’m glad he’s in good spirits! Fantastic that you’ve found a vet who’s a lot more pro-active as well, it makes all the difference!

My previous IC pig had a bladder flush as a “just in case”, would something like that be available to you? Sounds like you’re doing everything you can, he’s in good hands! It’s so difficult when you just want them to be better.

Are you weighing him regularly to monitor his weight just in case? Sometimes bactrim/baytril can reduce appetite but not always. Pro-biotics definitely help!

I’m glad he’s passing it, poor love! No wonder he’s uncomfortable bless him but hopefully that’s temporary on his road to recovery. I hope he feels better soon! 🥰
 
You’re absolutely right, it’s so hard to watch them hurting…feels like you’re holding your breath waiting to see if the next thing is going to work.

I did discuss a bladder flush with the vet - she said the practice does them on cats/dogs, but doesn’t do them on piggies or other smaller animals because of the increased risk of bladder rupture/other structural damage due to their small size.

His weight has been overall stable thankfully, the Bactrim doesn’t seem to affect his belly too badly - knock on wood - and he LOVES his probiotic!

Just gave his first dose of gabapentin (which he hates apparently) and his first subQ fluid bolus (which he REALLY hated…I’m a healthcare provider and usually pretty good with this stuff with my animals, but this had me in tears) so we will see how we go. I think I’m also going to go ahead and order some Cystease.

Thanks again for your responses. It feels better just knowing someone has gone through a similar situation and I really appreciate it 💕 I hope your piggy is doing better!
 
Just wanted to update, maybe more for my own processing than anything else.

I’ve been doing the nightly subQ fluid boluses, gabapentin, metacam, Cystease, and completed another 14-day course of bactrim since the last post. Pollen was still peeing a lot of blood and still hunching up and crying out with peeing and pooping intermittently. After another discussion with the vet last week, I brought him in again 2 days ago for a CT scan.

The CT scan showed a huge stone occupying almost all of the space in his bladder, an extremely thickened bladder wall, lots of sludge in his right ureter with some dilation of the ureter, and another large stone in his right kidney itself. It also showed inner ear disease, and some findings in his lungs that were either scarring (he’s never had a known URI since I’ve had him) or cancer.

The vet offered surgery to remove the bladder stone, with the knowledge that he has lots more sludge and the kidney stone and that the likelihood of him developing another stone and/or obstructing is high. I did not see the wisdom of putting him through that surgery only to have him continue to suffer, and my vet was in agreement. She maxed out his gabapentin and metacam dosages, added Tramadol, and I essentially took him home on palliative care.

Since being home he is definitely a bit more comfortable, but I think that’s mostly because he’s pretty sedated most of the day on this combo of medications - and he is still intermittently hunching up and crying while going to the bathroom. The hard part is he still sometimes is coming out of his hidey, eating all his lettuce, slurping his water, and munching hay.

After watching him these past 2 days, I’ve made the decision to bring him in tomorrow to have him put to sleep. My greatest fear is that he suddenly decompensates (in his case, that would likely be from obstruction) and is suffering until I can get him to the vet, or even worse that it happens while I’m gone at a 12 hour shift. He still does have some quality of life, which is making this so hard - but he’s still crying out while practically fully sedated on pain meds.

I’m heartbroken and feel so guilty and sad. I’m selfishly not ready to let him go, but I want to keep him from suffering any more than he already has.
 
I'm so sorry, you have made a hard decision but if he's so poorly it's the compassionate thing to do. For what it's worth, you have all my understanding and support, as I'm in the exact same boat. Two of my boys are/were like that. Some piggies react more strongly to anesthetics, after the surgery one was up and running a few hours later and the other took 3 days to recover. One kidney stone isn't necessarily a death sentence, as long as the other kidney is fine.
That being said, you know your piggy best and what he's like when he feels really good, and if your gut tells you it's time, trust your gut. You took great care of him. Personally I think I tricked myself a bit into overestimating their quality of life, until it became too obvious that it just wasn't good enough to keep trying. I am truly sorry you have to go through this. Lots of love to you and Pollen, I hope you get a happy time together until the time comes to go to sleep. ❤️
 
I'm so sorry to hear your news but I think in your shoes I would make the same decision. If he survived a stone surgery (and it's a big if - I've lost them before from GA) there is a decent chance he would go straight back into forming another stone and you would be back to square one. My beloved old boar (6+) did exactly this in Feb: another huge stone within a month of a surgery although I actually believe it started to form within the first week. The thickened bladder wall will be painful for him. You're making your decision out of love x
 
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