Infection revisited: second opinion?

Talishan
You can quote me

Post   » Wed Jun 28, 2017 3:28 am


Okay. Ditto to the advice you have received above.

Baytril is one of the few antibiotics guinea pigs can take that can address an inner ear infection. If you can get Lulu through this AB course, I think it's important; otherwise the inner ear infection will only get worse, and/or continue to episodically return.

That said, she HAS to eat and drink. Don't force fluids; the risk of aspiration is too great, but of all the stuff you've bought I'm hopeful she'll like at least one of them. Chill all and offer them via syringe, ice-cold from the fridge.

Unless your other pig is on antibiotics himself, or has some kind of intestinal parasite (highly unlikely if he's been well cared for and housed indoors), his feces are safe to give Lulu. Even if he did have lice or a mild case of mites, for example, that would not matter. Only the health and stability of his GI tract matters.

There's no strict or standard dosing regimen for probiotics; they're a supplement (necessary in this case), but not a medication. It's pretty much "freehand". Dissolve 4 or 5 of your male's droppings in some warm water and give it to Lulu, or mix it in with Critical Care, carrot or squash baby food, or something similar that can be used as a carrier. Do this 1 to 1 1/2 hours AFTER each Baytril administration. More throughout the day, in with handfeedings, won't hurt.

Critical Care: at least 60 cc's daily of mixed paste per kilo of pig daily for a pig that's eating nothing on her own. More is better but may not be manageable. Smaller feedings (10 cc's every 4 hours) are preferable to large feedings (20 cc's every 8 hours), but do the best you can, assuming you have a job, a business, school, kids or w/e.

Go by her weight as to how much CC to give her if she's eating at all, anything, on her own. Ideally you want to prevent weight loss. Realistically you want to minimize weight loss.

Keep going. Don't give up. Give her good care aggressively and she can recover.

Talishan
You can quote me

Post   » Wed Jun 28, 2017 3:41 am


Pedialyte is also "freehand". If she likes it, give her as much as she wants. We've had pigs to take 20 or 30 mLs at one time, several times throughout the day.

Forcefeeding: what we do at our house is I hold the pig securely (see pic):

http://www.guinealynx.info/handling.html

and my husband feeds. My husband is slightly shorter than me. Of you and your gf, have the taller one hold and the shorter one feed.

Use a 1 cc syringe with the tip cut off and the edges smoothed (see Lynx' handfeeding link above). Hold the pig's head firmly (careful of her eyes), and work the syringe into the side of her mouth, behind the incisor teeth. Then straighten the syringe and depress the plunger SLOWLY.

Guinea pigs can hold about 1/3 to 1/2 of a 1 cc syringe's worth of food in their mouths at one time. Let her chew and swallow, then depress the plunger again. Then refill and repeat.

You have to be firm. It may feel cruel and abusive, but she HAS to eat. You will be saving her life if you do so.

Good luck and let us know how things are going.

User avatar
Kimera

Post   » Wed Jun 28, 2017 4:04 am


Try to flavour the formula with vegetable juices, or dried and powdered herbs. The more agreeable the food, the less problems you will have with feeding. In most cases they tend to think that "rescue food" formula is a great treat. In my country there is a variety of "critical care" type formulas (for example Dr. Ziętek's) available for guinea pigs, with different flavors and various recommendations for use as diet supplements in treatment of, e.g., liver problems (Hepatoherb) or kidneys (Nefroherb), or GI tract (Diaroherb), etc., or plain "critical care". All of them are apparently so tasty that my guinea pigs always eat eagerly and try to tear the syringe from my hand. It has to be a really sick pig to show little interest in the mush, and even then I manage to give them at least a little without any struggling.
Try to make the feeding as little stressful as possible to avoid dangerous aspiration and tiring the patient.

Talishan
You can quote me

Post   » Wed Jun 28, 2017 4:16 am


This is good advice.

Guinea pigs pick up readily on stress and tension (most prey animals do). Allow plenty of time for handfeeding; don't try to rush it, and try to stay as relaxed and calm as possible.

It's overwhelming, frustrating, and seems impossible at first. It does get easier. You will develop the skill, and a rhythm with Lulu, that will make it easier going forward.

NeoLeo87

Post   » Wed Jun 28, 2017 6:46 pm


Updates 6/28/17 - A second opinion

Hi gang,

Due to stress and uncertainty, I made a last minute decision to take Lulu to the LSU school of veterinary medicine. My girlfriend had recommended it several times. Being an actual hospital, the students and doctors there are always keeping updated on the newest findings and research. I really wanted a 2nd professional opinion about Lulu (being so unhappy with the regular vet).

Road trip
It was a 1hr30min drive to Baton Rouge, but we pulled through. A doctor from the regular vet clinic called me back. I asked him what he thought of giving Lulu pedialyte. He said "absolutely NOT!" claiming that the ingredients in pedialyte could introduce new bacteria that might be harmful, on top of what's already there. He also did not recommend any probiotics, seeing how Ciprofloxacin works for 6 hours, so giving her any probiotics an hour later would be irrelevant.

Of course, this worried me. I gave Lulu critical care with pedialyte earlier that day. But we rushed to the hospital regardless. At first, we spoke with a med student. While not as practiced as, say, a regular staff member at a clinic, a student seems more enthused and eager to learn, and I appreciated that. I told him everything I could about Lulu's history, including the most recent upset (and everything on this thread). When we finally met the doctor, she examined Lulu and said at first glance she sees nothing that stands out. Her eyes and nose are fine, her teeth - at least in the front - seem fine. She was active and alert when handled, and she pooped some during the visit (small poops, but moist). She didn't mention if there was bloating or not, but when I brought up the pedialyte issue, she chuckled and said "Pedialyte is fine - as long as it doesn't become a regular thing. It shouldn't be part of her diet, but a little won't hurt." She even knows the doctor who said no to pedialyte. But again, this hospital seemed more up to date about studies for animals of all kinds, including guinea pigs.

I had a lot of questions for the doctor, including "poop soup." She said she knows about "fecal transplantation," and has heard people often try this, but she would not recommend trying it directly by syringe, regardless of the other pig being antibiotic-free; without knowing the other pig's health, she wouldn't advise it. She also elaborated more on why there is no probiotic "specifically made for" guinea pigs; they have a rather picky and particularly sensitive gut. Someone could make one, but nobody has yet, far as she knows. Bene-bac is an option, but she - like the other doctor - said she doesn't believe it would make much difference, nor does she think the antibiotic is doing nearly as much harm as it could. Cirpofloxacin is one of the safer antibiotics for small rodents, and the amount I'm giving - with only a few days worth - shouldn't be that severe.

We talked a lot, but the actual procedures won't take place until tomorrow. Lulu will get a skull x-ray to look at her teeth and roots, and see if there are any that need filing down or removal. If that's not the case, they're doing blood work. The overall charges seem affordable, which I was also happy with. The doctor recommended I continue the cipro as scheduled, along with metacam, and provide 6-12cc's of critical care a day (one of those 4 dosages can be with pedialyte instead of water, if I felt it necessary).

Lulu's health
Lulu's overall behavior has been hit or miss. When active, she seems normal (in fact, as I type this she's "popcorning" a little in her house). Other times, at rest, she puffs up into a ball and lies still, sometimes for a couple hours. I know she doesn't feel well, but I also know she's getting the proper medication she needs right now. Below are pics of Lulu from this morning, having force fed her metacam, cipro, and about 6cc's of critical care (some with pedialyte). She fought me, but not nearly as bad as yesterday. Then she got her veggies, and chewed her vitamin C tablet much better today. She hasn't drank any water, I think, but she got fluids in her critical care (and she will get more tonight).

Daveandtiff, thank you for the advice on probiotics. I do know that Popcorn (the male pig) eats his poop, and the nutritional and health importance of the "poop soup" technique seems sound, but again, I'm taking what I hear online with a grain of salt (not to downplay the valuable advice from experts, but to be cautionary (especially with a pig that has such a sensitive immune system)).

Lynx, she is maintaining weight. The last few days she's weighed 729-735g on and off, so it's hardly a change. She is also pooping. Mostly it's incredibly small and dry, but other times it's a bit larger and moist. I think the current diet she's on - with her meds and the critical care - are doing right by her, so far.

Talishan, thanks for the detailed and thorough reply (as always). With your recommended dosage of probiotics and poop soup, I'm curious to show your posts to the doctor (from LSU vet school) tomorrow and see what she says. And I am definitely going to try that holding technique (she is so slippery and strong, it's hard for me to keep grip on her with a towel while she sits).

Kimera, thanks for the flavoring advice. She did take well to carrot juice, so I may re-introduce that with her next dosage of critical care tonight.

Below are pics

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User avatar
Lynx
RESIST

Post   » Wed Jun 28, 2017 9:29 pm


She is looking perkier!

See also:
www.guinealynx.info/probiotics.html

User avatar
daveandtiff

Post   » Thu Jun 29, 2017 12:32 am


Have you been documenting times she is taking certain medications? What, how much of and what times what she is eating/drinking? If she is showing appetite or lack of appetite? And the times she is having particularly better moments or particularly puffy/hunched moments?

Talishan
You can quote me

Post   » Thu Jun 29, 2017 2:40 am


Geaux Tigers!

You made absolutely the right call in taking her up there. (Always listen to your girlfriend from now on, tell her I said that. :-)

The vet is absolutely correct; there is no commercial probiotic that contains the exact microbes found in a guinea pig's gut. We have had some success with both Probios powder and Bene-Bac gel, but that is variable; they are not perfect. Usually if inappetance/tolerance problems occur we suggest switching to another antibiotic; Baytril, however, is usually best for an inner ear infection. Chloramphenicol has superior penetration capacity, but it can also be hard on their GI and it depends on the actual bacteria causing the problem.

It's my understanding the guinea pig's body, if given Baytril, metabolizes it to cipro and it is that which actually does the work. Giving the metabolite directly, as cipro, may help lessen some of the GI impact. If you show this thread to the doc I'd be very interested to hear what she says.

Her eyes are bright; she looks well-hydrated. You're doing a great job caring for her.

You absolutely made the right call here and I think they're doing the right things. Please let us know how it goes.

NeoLeo87

Post   » Mon Jul 03, 2017 10:53 pm


Update: 7/3/17 - Lulu's state, post-visit

Hey gang,

Sorry I didn't get back sooner. With Lulu's health looking better, I've been busy with things that were put off til now. The vet visit at LSU hospital went long, but well. Lulu got a skull x-ray, and we double-confirmed what showed in her full body x-ray back in January. The bullae (inner ear) has leftover chronic infection (possibly residual from the URI she had several years ago) and it may have never cleared up. Where humans have puss, guinea pigs develop something more thick like "cottage cheese," hence this infection is not easy to drain. The doctor highly recommended to NOT do surgery on the inner ears - it's a high risk procedure for guinea pigs. However, the doctor noted that it appears the buildup cleared since January, but is still present. She suspects the ciprofloxacin is working, but requires more. We upped the dosage from .25cc to .3cc, taken every 12 hours for the next 2 months, to see how she does.

So far, doing good! Lulu is looking / acting more like her regular self, despite the increased dosage. Her weight (last few days) has fluctuated 695-705g. Keeping close eye to make sure it doesn't decline. She does have a few "wetter" poops, but still pellet-shaped (no diarrhea). A lot of poops are small and dry, but the doctor said that will happen if she's only eating veggies and a few pellets. The bulk of their poop takes shape from eating hay, or getting a lot of fiber. Lulu doesn't eat hay, so hence, smaller poops. We also found that Lulu's teeth and roots are totally fine - good, even. We may never know why she stopped eating hay, but some pigs are picky eaters. Lulu may just not be interested.

Can't seem to get Lulu interested in critical care, either. I've tried mashed carrots, pellet paste (made with some water at home), and even a little metacam at the tip in case she likes the flavor. Nothing. She's been force-fed critical care along with her cipro, and she hates it. She hoots with terror every time I come near her cage. I wanted to see if it had any effect leaving her off the critical care today, and just sticking with her dose of metacam and cipro. I even called LSU (didn't get to talk to the doctor, but talked to a student) about whether I should try to take her off the critical care for a day. She said as long as Lulu is eating/drinking, it shouldn't be an issue. She reminded me (as the doctor said) cipro is one of the safer antibiotics for pigs, and shouldn't disrupt her GI too much.

Speaking of critical care and probiotics, I brought up Talishan's comments to the doctor about "poop soup." She basically said that while she's heard of it being a home remedy, she hasn't seen any scientific, professionally-documented proof that it works (note: the doctor also has a relative who owns a guinea pig). And again, due to the fact we don't know the male pig's current health, I was not be advised to try it from scratch. Above all, if Lulu is doing fine, there's no need.

And Dave&Tiff, yes, I have been documenting things (given what time I can be home, of course). I almost have a perfect mental note, bored into my brain, of the times when she's puffy/sleepy or active, when she gets her meds, when and how much she eats.

I don't doubt the benefits of probiotics, but unless we see any red flags or cause for concern, we're going to stick to the metacam and cipro, and make sure she's getting plenty of her usual food. I'm going to pick up a different flavor of critical care as well, see if we can't get her interested in that.

Talishan
You can quote me

Post   » Tue Jul 04, 2017 8:26 am


The doc (and you) are absolutely correct. If the cipro is NOT messing up her GI, or causing inappetance, listlessness, excessively soft stool or lethargy, don't worry about it. We've had a few pigs to be completely untroubled by some of the strongest ABs guinea pigs can take. They're the exception, not the rule but if Lulu is one of them, wonderful and I am thankful for her and for you.

I also concur with the vet's assessment. Surgery to open this up is extremely difficult and dangerous on an animal as small as a guinea pig.

Higher doses/extended courses of the appropriate antibiotic are imo the right call. In my limited experience with this, if the pig is going to have trouble with the AB, they're gonna have trouble at any dose. If they don't have trouble, they don't, even at higher doses and extended courses. I think what they're doing is exactly the best course of action to clear this.

Try mixing canned pumpkin (pumpkin only, not the pie filling) into her Critical Care. Sometimes carrot baby food, squash baby food, or some of the vegetable blends that come in squeeze packets make the CC more palatable, as well as trying the other flavor of CC.

Glad to hear she's doing better. Please keep us posted. And bless you and thank you for caring for her so well.

NeoLeo87

Post   » Mon Jul 10, 2017 11:46 am


Update: 7/10/17 - New problems? "Drunk" pig

It's been a week since my last post. Lulu has been improving from her infection, in ways she hasn't in over a year. Her poops are almost as large as the male's, and she is eating/drinking plenty.

However, as of this morning, she's showing weird symptoms... When she walks, her behind has a little "sway" to it. She rarely keeps herself up on her legs when standing, but rather sits down, like she's at a rested position constantly. Her attention and appetite seem normal, but the "drunken" behavior is weird. It's like her equilibrium is off, again.

Lulu was given a new dosage by the LSU hospital - 0.3cc's of ciprofloxacin. She took cipro before the LSU visit, at .25cc's, and when I upped the dosage to 0.3, she seemed fine. However...I just ran out of what the old clinic gave me (what she's been on, at 25mg in the bottle), and provided the new bottle of cipro the hospital gave me (which is 50mg). The dosage appears more milky white than the one provided from my old clinic, perhaps from the double dosage, and Lulu weirdly takes a liking to it more. But she has not shown these "drunk" symptoms until putting her on this new bottle of cipro last night.

I called the hospital, and apparently the doctor we saw was finished with her internship, so she won't be coming back. We have to hear from someone else who can look over her charts.

So what's going on here? Is there something up with the dosage that the LSU hospital provided? Is this an overdose? She hasn't shown diarrhea yet, could just be the infection is getting worse. Below are pictures of the bottles to show the difference, and Lulu's stance. I'm really worried. I may have to take her in for another emergency visit (and this time to the clinic. The LSU hospital is too far away for a visit today).

I'm really worried about her.

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bpatters
And got the T-shirt

Post   » Mon Jul 10, 2017 12:42 pm


To take care of the horses before the zebras, is there any possibility that she has a vitamin C deficiency? Weakness in the back legs is very often the first symptom of that.

The stronger dosage of the cipro is unlikely to cause the milky color, but this new bottle could well have been compounded with something that does cause the color. The fact that she likes this medicine indicates to me that they've used a compound that she really likes, and maybe didn't much care for the old one. My vet gives a strange strength of Baytril because the compounding liquid is so palatable to pigs -- they really love it.

I don't know whether the cipro could cause the leg weakness or not. I've had a pig on cipro who didn't have that problem, but that means nothing. But do watch for diarrhea or loss of appetite.

Talishan
You can quote me

Post   » Mon Jul 10, 2017 5:36 pm


Ditto bpatters.

I can see the dose on the first bottle: 0.25 cc of a 25 mg/mL solution, or 6.25 mg per dose, dosed twice a day.

I can't see the dose on the second (LSU) one. I see 50 mg/mL, but what is the dose (in cc)?

How much does Lulu weigh?

Baytril has a range of dosing, so I'm going to assume cipro does too. This may be no problem medication-wise, but please do let us know what LSU says after they review her history.

NeoLeo87

Post   » Thu Jul 27, 2017 4:11 pm


Update: 7/27/17 - Stressful times

The last couple weeks have been hectic, which is why I haven't replied. To update on the last post, Lulu was taken to an emergency visit. She was seen by both doctors at the clinic, and I spoke to one afterward. In short, I should expect this to keep happening, on and off. The doctors called it "the infection flaring back up," and while this was a good call for an emergency visit, there will be times, or certain days, that her health declines rapidly...then slowly gets better in a few hours (and days). Also, at the end of the visit, Lulu was completely fine afterward. Nobody really knew why. This was on July 10.

Fast forward to now. I went out of town for a 4 day vacation. While I was gone, my roommates were taking care of the pets. They told me on Wednesday morning (July 26) that Lulu was on her side, and was stumbling around (her equilibrium was off). See the pattern here? I made another emergency visit, had a roommate rush Lulu to the clinic, and administered with sub Q fluids and a vitamin C injection. When I asked what they were for, I was told "to keep her hydrated and feeling better," but that's about it. She gets a vitamin C tablet daily, so I'm not sure what the injection was specifically for.

During her visit, they told me her teeth and GI tract seemed good, but that she had discharge from her nose. I told the clinic that she's been receiving - at least to my knowledge while out of town - the usual dosage of 0.30ml ciprofloxacin every 12 hours. Due to Lulu's critical state, one of the doctors suggested taking her off cipro, and putting her on doxycycline (10mg/ml, at 0.35ml every 12 hours). They gave her a dosage at 3:45pm, and said she was "stable" and could go back home. My roommates gave her another dose of doxycycline at 7 or 8am this morning, so I'm going to give her another dose this evening.

Lulu is currently sitting in a puffy ball. She is keeping upright, but walking slow. She scratched with her back leg at one point, and toppled over, but otherwise I haven't seen anything since being back home. I'm keeping a close eye on her.

What does anyone think of the doxycycline choice? I'm looking for more opinions, because I've just never been convinced with the work the clinic has provided me.

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bpatters
And got the T-shirt

Post   » Thu Jul 27, 2017 4:24 pm


Without reading back, have they tried a nebulized antibiotic for her snotty nose?

NeoLeo87

Post   » Thu Jul 27, 2017 6:14 pm


Emergency update: Declining health?

Lulu has been lethargic and resting, as mentioned in the last post. However, her back legs would give out a couple times to the side, and at one point she lay completely on her side. She didn't seem to notice until I moved the cage door and she jumped back up. When awake, she moved around, ate pellets, drank water. But when rested, it's clear her equilibrium is still off.

I called the vet. The doctor said it sounds like she is declining, and said I should prepare to talk about the next steps, possibly euthanasia.

I made an emergency visit, but the clinic said the doctor has an errand to run before leaving town, so I would have to wait an hour and half before he sees Lulu. I tried to argue with it, but it got me nowhere, and didn't really matter. Traffic made the drive very slow anyway.

My girlfriend and I are at the vet now. We put Lulu back and we're just waiting.

bpatters, I don't think they tried a nebulized antibiotic, but the nose issue only came up yesterday, so I'm not sure it's the biggest concern right now.

User avatar
Lynx
RESIST

Post   » Thu Jul 27, 2017 8:35 pm


I am so sorry she is doing so poorly. She looks pretty miserable in her pictures. Doxycycline is an antibiotic that has been successfully used on guinea pigs.
www.guinealynx.info/antibiotics.html

bpatters suggestion of a nebulized antibiotic if this is respiratory makes a lot of sense. Gentamycin is a frequently nebulized antibiotic.

Talishan
You can quote me

Post   » Fri Jul 28, 2017 10:31 am


Ditto Lynx and bpatters.

Doxy is a fine AB to try, and it can have efficacy on a URI, so it may afford some protection from that if her snotty nose is in fact from a developing URI.

Before you make any hard decisions, is there any way you could have her seen again at LSU?

NeoLeo87

Post   » Fri Jul 28, 2017 1:29 pm


Update: 7/28/17 - "Critical" vs "stable"

Yesterday gave us a scare. I don't do well in stressful situations, nor with death, and had a lot of anxiety during the visit. I called for an emergency visit, but the only doctor that was available was going out of town, and had to run errands, then see Lulu in an hour and a half after the call. I tried to argue for an immediate visit, but they couldn't do much else. So my girlfriend and I took Lulu through traffic, for a long time, and finally got to the vet. We were told the doctor would be back by 5:30. He came back at 6:30, had two appointments, and finally saw Lulu.

Lulu was in "stable" condition, and apparently seemed fine. I had a talk with the doctor, voicing my frustrations about these constant emergency visits. I wanted to know when exactly she is "critical," or if I'm making mountains out of mole hills. The emergency visit she had on July 26 was indeed necessary, but the visit yesterday may not have been. The doctor said if she is lying on her side and unresponsive, then it is critical. If she can get back upright, and is alert, then it's not critical. The other reason he thinks she's lethargic is due to her lack of energy and weight loss. She weighed 697g the other day, and weighed 686g yesterday (a 11 gram loss in 24 hours).

After such a stressful day, we finally decided to take her back home. I woke up periodically and went to check on her during the night. She was mostly awake and active, eating pellets and drinking water. This morning I found her napping. Below are the pictures to indicate the progression from sitting to lying on her side. She responded and woke up when I opened the cage door, so I am going to consider this as "not critical." I also did some web searches on "guinea pig sleeping." It's possible that, due to stress and illness, she's just very tired and will sometimes sleep like this.

She responded well to the doxycycline and critical care (I added organic apple juice to the critical care, and she seems to like that much more).

Something on my "piggy bucket list" is to take them outside. We don't have a back yard, and New Orleans is really dirty, but there are parks around that my girlfriend and I have considered taking both pigs to visit. We want to make sure the conditions are suitable for them, especially for her, because I have no idea how long she'll live, and I would like to give her a chance to experience the outdoors while she's still with us.

Talishan, I could make an appointment with LSU today. I've spent a lot of money so far, but as long as she's not critical, I can make an appointment today. Unfortunately, I will be seeing a new doctor (the previous doctor was an intern, and finished their internship, so they are gone now). But, as the title of this thread says, a second opinion is always good.


Sleeping?
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After "waking up"
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bpatters
And got the T-shirt

Post   » Fri Jul 28, 2017 2:54 pm


I wouldn't take her to a park. There's no telling who or what has been on the grass. You can always grow some wheat grass in a window sill and put it down for her for floor time.

Her equilibrium may be off because of an inner ear problem. If it doesn't respond to antibiotics, there's probably not much you can do. But I agree with the vet that if she gets up and moves after one of these episodes, it's probably not critical.

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