Ongoing discolored urine - He passed. <3

[violet976]

Well, I'm not honestly sure what kind of news I have from the vet appointment today. I got very little information, was told that the vet had an emergency and had to leave and that I would come back tomorrow for more information. What little I have I don't fully comprehend as the techs weren't clear themselves and normally I would have my vet thoroughly explain the findings, what he thinks they may mean and what options I have. At the moment, this is all I know, and that's given I have it all comprehended correct:

I was told that they expressed his bladder, but did not do a culture as requested. They handed me the cup of what they expressed:

(more sizes of this photo here: http://www.flickr.com/photos/scarletnotion/10582799654/

(more sizes of this photo here: http://www.flickr.com/photos/scarletnotion/10582774956/in/photostream/

Since I couldn't speak to the vet, I'm not sure why a culture wasn't completed. The tech wondered if perhaps it wasn't done because it was almost all blood. Since I'm not familiar with cultures I'm not sure if what was expressed still should have been cultured or not to determine if perhaps this is still a nasty infection. If anyone knows more on this thought, I'd love input. I simply was told that it wasn't cultured.

I was told two x-rays were done, but they did not know if the ultrasound was performed or not. I was told that his bladder walls were very thick and inflamed, and I was told that tissue was in what they were able to express from him. Again, they could not tell me if the vet *thought* it was tissue, or if he had a method of determining that it was for sure tissue.

I was told that the vet told them he was going to try a few days worth of antibiotics, but when I questioned why just a few days instead of a hard, long 4-6 week treatment, they weren't sure. They also weren't sure if the vet may have meant we'd start him on that and proceed to other ab's from there. I was told that he was given an injection of baytril. I also asked if they knew that Merle was *able* to pee, my fear being I'd be bringing him home and what if he simply couldn't pee well and was backing up. They didn't know for sure but said that when they can do drops there usually isn't a blockage and it's more an issue of pain when peeing. I mentioned that I would be giving him pain meds when I got home, and the vet could call me if he had a reason not to. The tech thought endotorb was the best of what I had all things considered, choosing that over infant ibu and carprofen, but I'd really like the input of our forum experts on that matter. I do want to give him something because he sure is in pain, I just would like reassurance of if endotorb is probably best right now.

I was told the vet said he was suspecting tumor or cancer, and I asked if UTI was off the table due to something that was seen in the testing, and wont know until tomorrow when the vet can answer that. I don't want to give up on him, but I want to do what is right for him more than anything else. I simply am at a loss of what to make of what little information I was given.

I would truly love any input from the forum experts on this. I have no idea whether to really fear the worst at this point, or to still suspect a bad possible UTI and keep fighting. I have no idea if I still need to push for the culture that wasn't done, or if it's not on the table anymore due to what his expressed urine looked like. Any advice on what I should be asking the vet tomorrow, or what direction you would push if it were you with this minimal information would be much appreciated. I feel blindsided by todays visit and want to be as prepared as possible when I go in for further clarification tomorrow. I've already been there three days in a row and just want to get my boy better, if possible, but I want to be prepared in advance so I know what questions I should be asking and what I should be insisting upon to get to the bottom of this issue.

 

[Petunia]

oh my I have nothing to offer as far as what this might be, but I wanted to say I'm very sorry you and your boy are going thru this

:hugs: :hugs: :hugs: :hugs: :hugs: :hugs:

 

[jorats]

You can only do a culture if you have enough viable bacteria to grow so they may not have had any.
I wonder if a few days of antibiotics and then express the bladder again to see if there are any changes.

With that amount of blood and thickened bladder walls, I'm shocked the poor guy is not in extreme pain.
I wish I could tell you more.. the only way we fought our persistent hematuria was long term meds. Most of our guys died within days of starting hematuria and they were in obvious distress so I think your little guy is better off than ours.

 

[Godmother]

So sorry to hear what you are going through. Today I saw an ad somewhere telling people to get checked out if they have blood in the urine, because a common cause is bladder cancer. . Sounds like that's what your vet is thinking. Hope you find out more tomorrow.

 

[violet976]

just got off the phone with the vet. copied from what I relayed to Shelagh:

he said the urine was pretty much straight blood and tissue. he said he did an ultrasound and xrays. he said the wall of the bladder was about 10x as thick as it should have been and, as best he could describe, looked kind of cauliflower or brain like and some of that tissue was in what was expressed (keep in mind, some of my descriptions from him were prompted by him needed to paint a picture for me)
he said his suspicion is for cancer, and thinks exploratory wouldn't provide a benefit, but just an answer. that he wants to treat with strong abs which he'll research tonight, dex to try and minimize inflammation. he thinks he doesn't exhibit signs of pain either yet.
I asked him, with the type of cancer he suspects, do I need to consider that waiting until signs of discomfort is too late - he doesn't think so. he said what he thinks is happening is that the tissue is just bad tissue now - my understanding, not his description. he thinks that the muscle is just not there like it should be for him to squeeze the urine out

I'm still trying to process all of this. I'll be back with Merle tomorrow so he can see him again and give me abs. I suppose the surgery would be more for me at this point, for the answers I want, and not really a benefit to Merle himself. I was told stones were not the issue, nothing showing in the xrays, and that either the meds will work or they wont and I'll most likely be watching for quality of life.

 

[jorats]

What about doing a biopsy? Is that an option?


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[violet976]

I'm not honestly sure. I think it would involve a surgery to get the biopsy, if I'm not mistaken. Would the biopsy yield any results other than the bad news we suspect? So far those I have talked to seemed to lean against any surgery as most thought it could not yield results which would alter a course of treatment. The vet seemed of the opinion that it would either show cancer, in which case there wasn't much we could do, or it wouldn't show cancer, in which case hopefully it was something that the strong abs and dex would slowly improve.

A biopsy was never mentioned and no one has mentioned it yet. Is there a reason you feel it would be beneficial at this point?

 

[jorats]

You're right. The only thing the biopsy would do is to not go through with the meds.
I keep wondering if the poor fellow might have what humans get interstitial cystitis. That's an inflammation of the bladder but with no bacteria. It's pretty much a flare up and an ongoing condition controlled with pain meds only.
How does he appear to you? Is he happy and seemingly pain free?

 

[violet976]

From what I see of him, he seems very much like himself. He runs around, eagerly gobbles his food, drinks his water though, I don't think, quite as much... but I never sat and watched his intake so closely that I can't say that's just me being paranoid. His fur is not poofed at all, no porophyn at all, bright eyes. His only noticeable issues are the slight twitches sometimes when he pees, resulting in just some small output of very, very red urine now, and the ongoing sneezing that both rats are battling.

The plan from my vet is baytril 5mg/kg & clavamox [s:30fv0omi]20mg/kg[/s:30fv0omi] 30mg/kg twice a day for 6 weeks, and dex to see if we can get any of that inflammation down and to possibly provide him enough relief to be able to urinate easier. I did ask if he wanted to do the baytril/clavamox again since we did it for 10 days before and he says he feels it is the safest choice for everything going on with Merle. I'm willing to try it again simply because, although the urine analysis only looked slightly better after those 10 days, his urine was looking clear to me at that point. The vet also believes it is a small chance that this is a bad UTI we are dealing with, is leaning much more towards bladder cancer, but we're going to give the ab's and dex a try just in case we're lucky. I have a new bottle of dex being ordered for Merle, and was sent home with carprofen for pain as needed. Merle did another large, bloody pee on the way to the vet, whereas I usually just see tiny drops, and the vet said it's probably due to the fluids he was given yesterday or possibly the stress of the urine he expressed yesterday. So, basically, we're just looking to see if, by appearances, the blood in the urine lessens, and will also do more x-rays in awhile to see if his bladder wall is still so thick/inflamed. Palpitation seemed to cause him no pain at all, which the vet says also makes him lean more towards bladder cancer.

For pain meds, I'm not honestly sure if he should have them simply because his blood/urine output *looks* like he should be in a lot of pain, or if I should give them to him only when he actually shows outward signs of pain. I've never considered long term pain meds, so input there is great as well.

 

[jorats]

If he's on dex, he probably won't need pain meds...especially if he's not showing showing obvious signs of pain. He's a trooper that one!

 

[violet976]

thanks. Shelagh said the same thing for the pain meds, but recommended upping the baytril to 10mg/kg. I have enough at home to do that, and the vet was more than willing to go that high so we'll proceed with that course.

 

[jorats]

I agree with the baytril too. I really feel a low dose is a waste of time.

 

[violet976]

Luckily the vet seemed very responsive to my requests for medications. He even allowed me to calculate out how much was needed for such and such a dose for this weight for 6 weeks... etc, so I knew I'd come home with the right amount. He mentioned he wanted to do 5mg/kg of baytril simply because he was pairing it with another antibiotic as well, but luckily I have 5 more pills here, probably from Gizmo a month or so ago, so upping the dose at this point is no trouble. Really, we have nothing to lose and everything to gain, so why pull punches now, right?

 

[violet976]

Updated to add that the clavamox is actually to be given at 30mg/kg, not the 20mg/kg I wrote in my last post.

 

[Godmother]

Excellent. Your sweetie will now have every chance if it's anUTI. I'm glad to know that bladder cancer doesn't necessarily cause pain, so that even the worst outcome would leave him with some quality time.

 

[violet976]

Yes, at least I feel like we are doing what we can for him and have a bit better understanding of it. I can't say for certain he isn't in pain, which is why I asked to have the carprofen on hand, but I watched as the vet palpitated and he certainly didn't make any noise of seem to be in discomfort. The only time I suspect discomfort is when I see him sometimes doing little body twitches as he tries to get a few drops of urine out, but the vet also said that instead of pain, if could be that the his bladder tissue is compromised from cancer, which would include his muscle tissue and might mean that he just doesn't have as much ability to *squeeze* the urine out as he normally would, if that makes sense. That was my understanding of his guess. He said that because urinary infections are normally quite painful, not seeing signs of pain when palpitating makes him lean more as well towards cancer. We're still trying, but most of the experts I know seem to think a bad UTI is fairly unlikely at this point, and so we're just planning to spoil him as well as we can while he's feeling good, just in case. He'll be fat and happy if he loses this battle at least... he's got a chocolate cake baking in the oven specially for him as we speak. <3

I also just got a call from the vet's office as the vet remembered something we discussed, but forgot to give me meds for. I had asked about the possibility of iron or other vitamin deficiencies from all of the blood I'm now seeing when he relieves himself, and we both thought an iron supplement was a good idea. I was going to pick one up from the vet, but if anyone knows of any other supplements I should be giving him at home to keep him as healthy as possible, please let me know. Seeing so much blood in his urine is unsettling, to say the least.

 

[Godmother]

I bet he'd enjoy bits of cooked liver.

 

[YorkieLove]

I am sorry the results from the vet appointment wasn't better news. I am really hoping the meds will work and give you more quality time with your boy to love and spoil even more (if that is possible. ) Hang in there you are doing all you can to help your boy and he knows this. :hugs:

 

[violet976]

He's a vegan rattie, so no liver for him. I will be picking up the iron supplement for him as well as a fresh batch of dex. He's still in good spirits. His pees are now larger but still very very red. The color obviously, not so good, but at least I know he is able to relieve larger amounts at the moment instead of just the tiny drops I was seeing at the vet. The vet said to expect just that as he was given sub-q fluids for his ultrasound a few days ago, so I'm hoping he doesn't revert right back to the tiny drops of pee again just yet.

From here we just wait and see. He's getting his baytril, clavamox and dex now and taking it all just like treats, so there's that at least. And still gobbling up a storm.

 

[dspch911]

Your poor baby - I hate all this watch and wait - we're doing that too. Hope he gets better and the meds help! Hang in there :hugs: