Friday, March 16, 2012

909. Two guinea pigs not eating - white viscous urine, blood in the urine

Yesterday Mar 16, 2012 (Friday), I saw 2 cases of guinea pigs with urinary problems and reviewed the case with Dr Daniel as part of my mentorship program.

We had met an interesting and friendly experienced Australian banker who had travelled to all over the world to work, at Liang Seah Street at 11 am today. "How old are you?" he asked Daniel. He then told Dr Daniel that 20% of the young men of his age and new graduates are jobless in Ireland. He told me that my handshake was weak, compared to Dr Daniel. "Have you been to Timbuktu?" I asked him. "No," he said. "But I have been to various places in Africa. I was sad to see so many homeless children and the poverty."

P.S
I used to study English phases in primary school in the 1960s and there is a phase referring a distant place as Timbuktu which is actually present in Africa. I doubt I have a chance to visit it.

Case 1.
Not eating. Abdominal swelling obvious. The owner had seen me some months ago. "No more skin infection," she said. "My guinea pig is not eating."
Dr Daniel palpated the swollen abdomen. I did that after him. The swelling covered almost 90% of the abdomen. Soft distended bladder, in my opinion. I don't know what Dr Daniel thought. Was he thinking of ascites? Definitely, ascites present this pendulous abdomen.

Before I could speak further, the guinea pig squirted out white cloudy urine onto the stainless steel consultation table top. "The urine is not normal," I said. "I would take some for urine test." I took a new syringe to suck up some urine. The guinea pig voided much more urine. Thick cloudy liquid. As if the bladder had lots of white sand.

"Is it possible that my guinea pig has bladder stones?" the lady asked. "My other guinea pig had bladder stones. The vet removed it but then said another surgery had to be done."

"Why was there a need for a second surgery?" I asked.
"The first one was not done well," she said. "So, another one had to be done."
"What happened to the guinea pig after bladder surgery?" I asked.
"She lived for a few days and then died."
"In this case, the guinea pig might have or might not have bladder stones. We will wait for a few days and get the urinary tract infection treated first."

A follow up the next 2 - 7 days would be needed. X-rays would be needed to confirm bladder stones.


Case 2.
Not eating. Weight loss for 2 weeks. The owner had phoned me about bladder stone surgery. She had consulted Vet 2 recently and an X-ray had been taken. But two weeks ago, she consulted Vet 1 who gave a different diagnosis. Today she came with the X-ray as I had advised her to get it from Vet 2 to save her cost of the need to have another X-ray taken. Vet 2 had told her that the medical notes would be sent to me. "It is not the medical notes that is important," I said to the young lady. "It is the X-ray of the bladder stones and to see if there are other locations like kidneys and urethra where stones are lodged."

"The vet gave antibiotics for a gastric infection," the lady said. "But the guinea pig did not recover and was not eating. So I went to Vet 2 who took an X-ray and said there were bladder stones. She advised euthanasia."

"What was the original problem with your guinea pig when you saw Vet 1 as you said that your guinea pig was treated for stomach infection?" I asked.

"My guinea pig had passed blood in the urine."
"What did Vet 2 advise?" I asked. The lady was not so clear about this but she said: "I don't want the guinea pig to be put to sleep. She could not pee for the past few days and did not poop."

Smaller than normal 1-cm long faecal pellets were passed on the consultation table. I palpated the abdomen. "No swollen bladder," I said. "The guinea pig had passed urine and you might not have seen it."
"I saw a brown spot," the lady said. "Just that brown spot on the paper. I have separated her from the other guinea pigs"

"It is possible that you did not see the other spots if they are not coloured," I said. "Since I can't feel a swollen bladder despite you saying that the guinea pig had not peed, I would say that presently, the guinea pig had no urinary problem."

She phoned her mother regarding surgery to remove the bladder stones (> six of them). It was the cost of surgery quoted as $300. I advised against immediate surgery as the guinea pig was very thin and dehydrated. I asked her to syringe feed with the pink syrup, food and emergency care 6 times per day, as prescribed by Vet 2 for the next 2 days.

Doing bladder surgery today would have killed this poor-conditioned guinea pig. The antibiotics from Vet 1 and Vet 2 were working to clear the urinary tract infection for the time being. "Let her be much stronger to take surgery by nursing her the next 2 days," I said to her.

"In such cases," I said to Dr Daniel. "Immediate surgery is most likely to lead to death on the operating table." Sometimes, the guinea pig dies the next 2 days. So, it is better to get the pet stronger first.

A follow up 2-7 days is needed.

P.S. In Case 2, the worried owner did not say that the guinea pig had runny nose. I saw yellow fluid from the left nostril. "Your guinea pig has an upper respiratory infection and anaesthesia would be very risky. The guinea pig needs to recover from the infection." As you can see, an immediate operation would not be in the interest of the patient.

"Any death on the operating table is a very emotional affair for the owner and the operating vet," I said to Dr Daniel. "So, it is best to get the patient in the best possible health before any operation. Unless it is an emergency."

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