FIRST CONSULTATION WITH DR SING ON FEB 19, 2012
The young lady had consulted Vet 1 about her young guinea pig passing blood in the urine. Vet 1 had done the ultrasound and other tests which the young lady had not kept any records. The blood in the urine came again after a few weeks and she consulted me.
"Was a urine test done by Vet 1?" I asked. According to her, it was not done. A urine test is important when the complaint is "blood in the urine". It can tell many things as guinea pigs and rabbits may pass "blood-coloured urine" due to dietary causes. However the owner sees the reddish urine and thinks her pet is passing blood in the urine.
How to take urine from a guinea pig? For expediency, the vet usually gives the antibiotics, suspecting Urinary Tract Infection (UTI) and that would be the end of it. However Vet 1 apparently did many tests including ultrasound and had cost the owner a bundle. When the guinea pig passed "blood" in the urine again, she came to me for a second opinion.
In private practice, the clinical outcome is important. Otherwise, the owner just go to another vet as in this case.
Passing "blood" in the urine. Real blood. I used evidence-based medicine to diagnose this case. I hospitalised the guinea pig. As he was peeing "blood" in large amounts, I was fortunate to capture his urine and sent it to the laboratory for a proper analysis. My method is described in the images below.
5072 - 5075. 2nd time, the young guinea pig passes blood in the urine. Owner wants an answer. Practise evidence-based medicine by doing urine analysis & X-rays
Collect urine for testing. I used a clean plastic tray cover under the grating and a sterile syringe to collect the freshly passed urine. In this case, the guinea pig passes lots of urine and immediately. So I was fortunate enough to collect a relatively clean sample. He also pooped and this showed he was in good health. Weigh the guinea pig always. His weight was 500 g.
The next day of hospitalisation, the urine was no more bloody. I collected the urine in a syringe to show it to the owner and for this report. I did not test this urine to save costs for the owner.
The 2 X-rays showed some radio-opaque material inside the large intestines. Two views of X-rays are best as one view (lateral view) may not give a mis-diagnosis of the material as being inside the bladder.
The laboratory test showed "blood ++++" in the urine but no bacteria or white cells indicative of an infection. So, in this case, I was able to provide evidence to show the owner that her guinea pig was actually passing blood in the urine.
Practise evidence-based medicine. That is the way to earn the owner's trust. I also did 2 x-rays of the guinea pig's abdomen. There was some radio-opaque crescent material in the intestines. Could this be the "metallic" rust or some radio-dense chewing of the guinea pig? This guinea pig loves gnawing at everything and Dr Daniel was of the opinion that he had chewed some toxic matter.
(Later, in one photo below sent to me on Feb 27, 2012, you can see that the guinea pig was standing in a cage that is actually rusting)
SECOND CONSULTATION WITH DR SING VIA E-MAIL ON FEB 27, 2012
Other than that, please be careful about over-use of disinfectants and chew blocks that may have chemicals inside the wood. Toxins to the kidneys due to chewing of blocks and fence may also damage the kidney and cause blood in the urine.
On Mon, Feb 27, 2012 at 12:59 PM, ...@gmail.com> wrote:
He loves standing this way and the plastic screen is placed before the fence. However, what I noticed is that he's just grabbing the top edge to stand now. (You can see in the photo that the fencing was really rusty and the plastic fencing was used by the owner to prevent him from gnawing it. Later, I guessed that the young lady went to buy a new replacement fencing as the other photo showed white fencing (see photo below).
THIRD CONSULTATION WITH DR SING ON SUNDAY, MAR 4, 2012
Haematuria. "The guinea pig passes blood in the urine again yesterday," the young lady messaged Dr Daniel and came to the surgery. Yet, the carrier's absorbent litter showed just yellowish brown urine but the owner confirmed that real red blood had been passed at home.
"There are many causes," Dr Daniel enumerated UTI, stones that were not visible on X-rays, tumours. What to do? Go for a 3rd opinion? "You were supposed to be the 2nd opinion," she said.
So what was the cause of bleeding in the urine? Bladder or kidney problem? Hard to say. We did not actually see the "bloody urine" as the guinea pig came without having passed blood in the urine in his carrier.
"An exploratory laparotomy would be highly risky," Dr Daniel advised. The guinea pig was now 650 g compared to the earlier visit some 10 days ago.
I gave the following advices:
1. Feed the guinea pig organic vegetables, fruits and hay for one month.
2. No treats and pellets.
3. Feed the medication as before.
"How about dried raisins?" the lady asked. "They are his favourite."
"No raisins too."
Could raisins be the cause since the guinea pig had recovered the next day when hospitalised at Toa Payoh Vets and fed only vegetables and apple? Not a drop of blood. He went home and the cage was screened to prevent him climbing and chewing the wires (pictures given by owner).
Photo (left) is the photo of his new enclosure. You can see that instead of wiring, its the blue plastic on all 3 sides within the enclosure.
In the Photo, you can see that the blue piece is before the wiring. Also, you can see the small rubber tubing (fish tank cleaning rubber tubing, sliced along an edge) that I have just added to cover the top-most horizontal wires. I noticed that he doesn't bite this material.
In the Photo, it shows the clear plastic sheet on his enclosure door. It is also placed before the wiring, from Bean's perspective when he is in the enclosure.
Noted the possible toxins from the cleaning items, chew toys and cage wirings.
Name of owner
I will wait and see whether the guinea pig is OK. "Blood" in the urine may not be actual blood this 3rd time. The urine could be "discoloured" urine due to the raisins and diet. To save the owner vet expenses, I did not advise more urine testing and sent the guinea pig home on antibiotics and pred medication for the next 7 days. Three days later, I texted her and was told that the guinea pig did not pass blood in the urine. Then on March 9, 2012, I got the phone message below:
FOURTH CONSULTATION WITH DR SING VIA E-MAIL ON MAR 9, 2012
I just gave B.B a tablespoon of pellets as his weight is 500gm now. He stopped eating the veggies that he usually likes. I tried apples, carrots, romaine lettuce, butterhead lettuce and cucumbers, all to no avail. He just ignores them or just take a few bites. His consumption of hay has also gone down.
He's not peeing blood and since the protein content in his pellets aren't high, I reintroduced it. He went straight to eat it and seems to be happier. For the past few days, he's been going to the pellet bowl and looking into it even though it was empty.
Sent from my iPhone
REPLY FROM DR SING, MAR 9, 2012
Monitor n record amount n type of food daily. Wait n see.
Comments: It seems that the guinea pig has not passed "blood-coloured" urine since March 4, after replacing the rusty fencing (as seen in an email picture from the owner) and not giving raisins. Only time will tell whether the guinea pig will be fully recovered. The interesting aspect of this case is that there is no way the vet can know that the guinea pig had gnawed on the rusty fencing till the picture was received. So, could the rusty fencing be the cause of "blood in the urine? Rust could damage the kidneys and cause bleeding. This is one possible cause.
It is really difficult for a vet to diagnose this case if the vet does not do urine analysis and speculate that it is always a urinary tract infection. The guinea pig is a valuable family member to the younger generation and it is imperative that a correct diagnosis be made and in this case, urinalysis is mandatory. There is no point doing ultrasound and other scanning when the urinalysis can provide clues and is much less expensive and more useful. But guinea pigs don't pee a lot and it is extremely difficult to collect the urine. Therefore, hospitalise the patient!
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