Infection revisited: second opinion?

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daveandtiff

Post   » Fri Jul 28, 2017 4:07 pm


You might try gathering wheatgrass plants and putting them within a box cover to simulate lawn. If she's never been outside, germs was my first concern, too, with an immune system needing to stay at top order, but the smells, sounds and moving could be stressful. That's a nice thought for her, just be safe and watchful for her response.

NeoLeo87

Post   » Sat Jul 29, 2017 6:29 pm


Update: 7/29/17 - Some ups, some downs

Today is the first day Lulu has shown some normalcy. She walks around more often, drinks water, and has moist poop on a regular basis (smaller size than a week ago). She ate her veggies and her vitamin C tablet just fine. She's spending a lot of time napping, puffed up in a ball, but I haven't seen her slump over (if she has, I wasn't around to notice).

The downside, she has trouble eating pellets. She puts one in her mouth, drops it out. I think the metacam is no longer having much effect for her pain tolerance (the inner ear infection affects her back jaws, or so we assume). I'm going to mash some pellets with her critical care tonight, and give her some more that way. She gets 6cc's of critical care (mixed with some organic apple juice and water) each night, along with 0.35ml of doxycycline every 12 hours.

I can't make appointments until Monday, but I will make an appointment at the regular clinic, and at the LSU hospital again. Never hurts to get a second opinion. I'm just holding out hope that she gets better.

bpatters, yes, this thread is about Lulu's inner ear infection that she picked up when she was young, and survived, but never fully recovered. Now it's flared back up which is the reason for this thread. Previous posts will give more information. And thanks for the wheatgrass recommendations, I'll look into that in the coming days.

NeoLeo87

Post   » Sun Jul 30, 2017 11:16 pm


Update: 7/30/17 - Some improvement, but still sick

The Ups
Lulu is still eating her veggies and vitamin C tablet just fine, and drinks water. She walks around, even gave a brief "hop" out of the corner of my eye (she seems most active when nobody is watching). I take her out every night after giving her critical care with apple juice, and doxycycline (both of which she takes willingly and eagerly). She walks around the play pen with me, and when the lights go out at night, she's usually active and curious.

The Downs
But she also has her sick moments. When resting, she gets in a puffy ball, sometimes a little "jump," or an occasional twitch. Sometimes she will slump to one angle, but mostly keeps upright. She still has trouble eating pellets. I think it hurts her to eat them, due to jaw pain from the infection. She manages to eat most of her pellets at night, but it might have something to do with her critical care and antibiotic dosage.

Pellet problems
I was reading on here about pellet mash. Does anyone have a recommended recipe? All I've done so far is pellets and water, and let it sit in the fridge for a few hours. Should it be warm, or cold? Should it be only pellets, or include other ingredients? How long can it stay in the fridge? And how often can I give this if she's not eating enough pellets?

On Wednesday she weighed 697 grams; Thursday, 686g; Friday, 690g; Saturday, 697g. And tonight, 691g. Her weight fluctuates, but it's not going up as much as the vet would like to see. I'm hoping the critical care - and any pellet mash I could make - will help gain some weight back.

Lulu (lastnight)
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Her cage
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Her sitting posture
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Sleeps a lot like this.
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Pellet mashed in water
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bpatters
And got the T-shirt

Post   » Sun Jul 30, 2017 11:27 pm


Pellet mash should be warm. It's OK to keep some in the fridge, but when you microwave it, only do so for a very few seconds, and stir it and test it to make sure there are no hot spots in it.

There's no recipe for the mash. It needs to be very wet and thin if you're syringing it, but if she'll eat it on her own, you can make it thicker and put a glob of it on the plate.

Adult guinea pigs just don't gain weight in a hurry. As long as the trend is upwards, that's good, even if it's very small. It's like you trying to gain weight eating nothing but salads with no dressing. It just doesn't happen quickly.

User avatar
Lynx
RESIST

Post   » Mon Jul 31, 2017 6:08 am


There are a couple ideas here to make the mash more interesting:
viewtopic.php?t=56986

She looks like such a sweet girl. Not reading back, but are you giving pain medication? If you are sometimes seeing her puffed up, it can help.

Talishan
You can quote me

Post   » Mon Jul 31, 2017 1:10 pm


Pellet stew: take some pellets, just enough to cover the bottom of a small cup. Put just enough warm water over the layer to cover it, no more.

Put a saucer or small plate over the cup to seal it. Let it sit for 20-25+ minutes (think Minute Rice). Uncover, and you should have a light, airy pellet crumble.

Mix with canned pumpkin (pumpkin only, not the pie filling), carrot baby food (the favorite at our house), squash baby food or similar. Put a glob of it on a small plate and see if she'll eat it on her own. We have held weight with several of ours doing this once or twice a day.

Pain med: ask the vet about using Tramadol. This is a mild narcotic that can really help when Metacam is no longer cutting it. It's more powerful than an NSAID (of which Metacam is one), but does not zonk them out like the more powerful narcotics/opioids like buprenorphine and butorphanol do.

It's a great "in-between" pain med we've used several times successfully.

NeoLeo87

Post   » Wed Aug 02, 2017 10:58 am


Update: 8/2/17 - Followup at LSU hospital

Lulu has been stable the last few days, and has shown improvement in her behavior. I felt it was a good time to make the long drive back to LSU for a second opinion. My girlfriend and I took Lulu for an hour and half drive - which was not fun for her - to Baton Rouge. We had to see another doctor, because the previous one finished her internship (that's how it works at a university hospital). After catching up the new doctor on Lulu's recent episodes, they gave her an exam. We were told some new information.

Apparently, the last x-ray from her last visit showed she had some "hooks" in her teeth, but not enough to raise red flags yet. They also told us that the exam showed she may have vision loss. They aren't sure whether it's neurological or not, or if it has to do with any possible brain tumor. But for now, their biggest concern was her weight (690~ grams). Because her white blood cell count was low during her last visit, the doctor wants to avoid hypoglycemia. They recommended feeding her double her regular food (2 cups of veggies a day instead of 1) and increasing her critical care from 6cc's to 10. They said to put her critical care mash on a shallow dish and leave it there for her to get when she wants. They also said to put her pellets in a shallow dish, too, because she may be relying on her smell more than her sight. That doesn't answer why she drops pellets out of her mouth or has trouble eating, but she is eating.

She has not been puffy today, but I did notice a few subtle "jumps" she gives when sitting still. It's hardly noticeable unless you look close. She also sometimes gives her head a "shake," like dogs do when they just had a bath. This happens when she gets her face wet from veggies, but also after getting medicine. I don't know if these signs are the infection, or something else entirely, but otherwise she's not showing any bad signs today.

Due to eating more food last night, she weighed 715 grams this morning. I trust the hospital is making a safe call by asking to double her food intake, but I'm wondering if 15 grams in 24 hours is just as concerning for weight gain, as it is for weight loss.

bpatters, you mentioned "Adult guinea pigs just don't gain weight in a hurry," so is this 15 gram spike a "hurry" or is that normal?

Lynx, Lulu is battling an inner ear infection and was prescribed ciprofloxacin. She has since been taken off when she had a "flare up," and is now on doxycycline (0.35ml every 12 hours, from a 10mg/ml bottle).

Talishan, thanks for the recipe. I'll give it a try if it looks like she has more trouble eating. For now, the doctor did not make comment about that, but simply mentioned giving more critical care and leafy greens, stating that greens are "more nutritious" than other vegetables, so if anything is given, it should be more lettuce. I asked about Tramadol, and the doctor/intern said I could always try it, if I felt like it, and didn't seem decisive one way or the other. She seemed less concerned about the pain medication, and more concerned about getting her antibiotics, gaining weight, and avoiding any further illness as a result of low weight.

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bpatters
And got the T-shirt

Post   » Wed Aug 02, 2017 11:54 am


Fifteen grams is a very small amount, less than three teaspoons of water, and doesn't represent a real weight gain at all in just one day's time. It could be due to the fact that she hasn't peed in a while, or pooped as much yet. You'll have to watch it over several days to see which way the trend is going.

Talishan
You can quote me

Post   » Wed Aug 02, 2017 5:11 pm


I concur with LSU and bpatters.

The more Critical Care you can get into her, the better her weight should be.

I wondered about teeth when you mentioned her pellet issue.

Keep going. One step at the time. CC and pellet stew for now.

User avatar
Lynx
RESIST

Post   » Wed Aug 02, 2017 10:20 pm


Your answer to me mentioned antibiotics, not pain medication. Pain meds can be a valuable tool, since a guinea pig in pain will not eat as much.
www.guinealynx.info/pain.html

If I were reading your most recent post all by itself, I would push looking into teeth issues.

Talishan
You can quote me

Post   » Thu Aug 03, 2017 4:24 pm


Ditto Lynx. Teeth issues can hurt, and a flaring ear infection definitely hurts. A guinea pig in pain won't eat properly, if at all and pain medication can make an enormous difference. Without reading back, is she currently on any pain medication at all?

Try feeding her fresh corn husk. Get some sweet corn, discard the outer (dirty) husk pieces, then rinse the inner pieces. Tear into long, thin strips and offer them to her.

Many pigs love corn husk, and they have a LOT of silica in them, even more than some grasses. They may help keep her teeth worn down, at least a little, while you are getting her teeth, ear and other issues sorted out.

NeoLeo87

Post   » Thu Aug 03, 2017 4:46 pm


Update: 8/3/17 - Popcorning, chirping, (but still pellet problems)

I came home last night to a very different guinea pig. Evidently, Lulu is feeling well right now. She was active and running, sleeping without looking puffy, and even made some vocalizations I had never heard before. There was a strange noise coming from my bedroom, and when I checked, I heard this "chirping" sound. I was alarmed, and brought my hand in the cage to gently pet her and see if she was alright. She immediately stopped, made a scared purring sound, and walked around the cage. When I did some research, I found that chirping is a rare sound, and could mean a number of things, including a trance - which may explain why she suddenly stopped. I'm going to assume it wasn't a bad noise, since she appeared fine. But I recorded the noise to keep for record.

Her weight is fluctuating frequently. Yesterday she was 715g, this morning she was 690g. We are just going to keep watching her weight, and make sure it goes up.

I also wonder if she's in "heat." She was never spade, and she's been making the same purring / squirming her butt movements that Popcorn sometimes does when I bring my hand up to them. It's hard to tell, because I've never seen her so...normal. And normal, right now, is unusual.

As for diet, she's been getting 2 cups of veggies per day (one at morning, one at night), a vitamin C tablet, 10cc's of critical care, and pellets. Now...the pellets are still an issue. Despite her good behavior, she still has trouble eating pellets. I even put them in a shallow dish (for her eye sight, the doctor suggested?). But without looking at the teeth, we have no way of knowing why she won't chew pellets. She picks them up in her mouth, drops them out, repeat. Sometimes she manages chewing one, but mostly they fall out. And I know she's hungry, she keeps trying. She's a trooper.

I think the best course of action is to get her x-ray and blood work ASAP. I want her handled under stress when she is at her best, not when she's already critical and feeling down. I'm waiting to hear back from LSU to set up an appointment. If we can figure out the cause for pellet problems, that is one more step in the right direction.

Lynx, she takes 0.25ml of meloxicam in a 1.5mg/ml bottle for pain. She's been taking it since January (every single day) as requested by a doctor at our regular clinic. The purpose of blood work is also to see if the constant meds have any side effects, but last time we checked, they didn't. Hopefully this catches you up on the thread now.

Talishan, the pellet stew didn't quite work. She sniffed it, and gave up. Pics below will show how I presented them (one side plain pellet mash, other side with pumpkin). She just prefers struggling with regular pellets. Hopefully there's another method that will work.

Dish of pellets, and critical care (didn't quite work, just got her paws and cage messy)
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Pellet "stew" (one side regular, other side pumpkin (she did not like this))
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bpatters
And got the T-shirt

Post   » Thu Aug 03, 2017 4:48 pm


My suggestion is to make the pellet mash a LOT thicker, so it sits in a glob on plate. Experiment with different things to mix with it, starting with stuff you know she likes.

Talishan
You can quote me

Post   » Fri Aug 04, 2017 4:50 pm


TEETH. Teeth teeth teeth. X-ray fine if you want to do it; bloodwork I wouldn't bother with.

I'm really glad to hear she's feeling so much better. Thanks for the update. But if you can get LSU to trim the "hooks" under light sedation, I think she'll resume eating her pellets.

Continuing good wishes to her and to you.

NeoLeo87

Post   » Sat Aug 05, 2017 8:56 am


Update: 8/5/17 - Opioids, UVB lights, and gassy GI

Lulu had a long day at the LSU hospital yesterday. I took her in for x-rays and blood work. We are still waiting on some of the x-rays, but here are the current results.

Not much has changed in her blood work. She had low white blood cells last time we checked, and that remains the same. An ophthalmologist declared that her eyesight is fine. She may have just been startled or stressed during her last eye test.

However, they did find palpation on her lower jaw, and a pained reaction to touching around the area. They suspect an infection in the root of the teeth, which may cause her difficulty eating pellets. For this, they suggest a CT scan of the jaws and head, and proceed with dental work, and that's not cheap.

Lulu also has gas in her GI tract. She said it could be a result of the increased diet on leafy greens and critical care, but this is what the doctor recommended doing in the first place. I'm going to call back and ask if I should cut back on the overfeeding, and ask just how serious the gas level in her GI tract was. It concerns me that the doctor seemed casual about that.

Recent studies show that UVB lights may help guinea pigs with low vitamin D, just like it helps reptiles. The doctor recommended I get a UVB light and put it on top of Lulu's cage, for 1 hour a day, to see if that rules out any bone pains she may be having. But they didn't specify vitamin D being an issue.

We have discontinued the meloxicam. Lulu has been on it for over half a year, and the doctor sees no reason to keep her on it further. We are switching to Tramadol - as mentioned by Talishan - on a light dosage. I'm told the main side effect is lethargy, and if I see this, to call back the hospital and see how we should change her dosage. The hope is that Tramadol will help with her tooth pain.

Lulu is still taking her doxycycline, increased 10cc's of critical care, and 2 cups of veggies a day. Her behavior is normal, except she's returned to puffy resting. I'm not sure if this is due to yesterday's car ride and vet visit, or if she's feeling worse (from teeth, ears, or gassy GI), so I'm calling LSU soon to confirm some of my worries.

bpatters, I will keep trying different things for pellet mash. So far, she doesn't like any, but the doctor said it will take time to introduce her to something new, if it's not already part of her regular diet.

Talishan, The "hooks" I will re-confirm with the hospital, but I'm pretty sure they found little concern with her teeth so far. It was the roots they seemed more concerned with, and the palpation when checking her jaws. She doesn't seem to be doing as well as yesterday, so I hope to get to the bottom of it today.

User avatar
Lynx
RESIST

Post   » Sat Aug 05, 2017 10:27 pm


Dental xrays should also show if there is an infection of the root. Puffy resting could indicate pain. I hope the Tramadol helps with that.
I am hoping for the best.

Talishan
You can quote me

Post   » Sun Aug 06, 2017 4:32 pm


Ditto Lynx.

I can't help but wonder if at least some of the reaction she had to jaw palpation stems from the inner ear infection. All these bones in mammals are connected, although obviously heads are shaped differently.

There are plenty of times I feel like I'm getting an achy tooth, but then if I gently massage the hinge of my jaw on that side I find it's the jaw, not the tooth.

Pure speculation on my part and take it fwiw. I bring it up only because the only definitive treatment for an infected tooth root in guinea pigs is, afaik, extraction. Dental extractions in guinea pigs are a bloody blue nightmare.

Gassy GI: nearly Every. Single. Vet. I have EVER seen, including some of the most cavy-knowledgeable, have called normal ingesta "gassy" on x-ray. That's not to downplay the seriousness of excessive gas if present -- but it seems to be a very common over-diagnosis. Again in the fwiw category.

If it were me I'd want a set of good, tight dental/skull x-rays before going to CT. That said, if you can swing it financially CT is a wonderful, amazing diagnostic tool, and they will be able to use Lulu's scans in teaching future exotics vets. The more cases and data they have, the more is learned, for Lulu and for others.

NeoLeo87

Post   » Mon Aug 07, 2017 12:02 pm


Update: 8/7/17 - Pellets, UVB light, pulling hair out

Over the weekend, Lulu has recuperated from a stressful visit to LSU. She is active in the morning when she eats, sleeps through the day, and is active again at night and throughout the night. Most of the day she spends sleeping, and only occasionally tries to eat pellets. I've also noticed she has been pulling hair out of her front legs (see pictures below). I'm not sure why, but I hope the vet will have an answer when the hospital calls me back. Is it a result of the infection? Something else?

As for her diet, Lulu still eats veggies, critical care, and a vitamin C tablet just fine, and drinks from her water bottle. But she still has trouble with pellets. When eating, she gives these "jerks" or twitches. Very subtle, but they happen when she is eating pellets or when she's resting. I assume this is from jaw/tooth pain. And I'm waiting for the hospital to tell me if we should change the dosage on her Tramdol, or if it's too early to tell. And, very weird, but she gets completely still like a statue, right after getting medicine and food. She does not look comfortable (see pictures below).

Also, Lulu still shows no interest in pellet mash. I have tried "airy" mash, "moist" mash, apple juice, carrot baby food, canned pumpkin puree. I've tried warm and cold. She takes none of it. I keep offering, though.

I was recommended to try UVB lights. 1 hour of exposure per day, 12-15 inches from Lulu. Here's a link to the one recommended by a med student at the hospital: https://www.chewy.com/zoo-med-reptisun-50-uvb-compact/dp/126585

I understand there can be side effects, like lesions on the eyes. As Talishan said, her jaw pain could be the jaws, not the teeth, so this is only speculation, but they want me to try UVB light and see if it helps with vitamin D deficiency. Any advice or opinion on the use of UVB lights for guinea pigs?

Lastly, Lulu needs her nails trimmed, but I know this is stressful for pigs - especially her. And with pulling out her hair, and her sickness, how safe is it to try and clip her nails right now?

Lynx, according to LSU, dental x-rays can show problems with the teeth, but not always the root. This is why they recommend CT scan. However, she hasn't been as "puffy" lately. She rests a lot, but she isn't puffy while doing so. That still doesn't explain pulling her hair out, though.

Talishan, we have no idea yet whether her jaw palpation is the ear infection, bone disease, or dental disease. Not sure what "fwiw" or "afaik" mean, but dental extraction was the next step after a CT scan. They didn't give me any alternatives, because if there's a root problem, that's the only way they could take care of it. We do have dental and skull x-rays, but I haven't heard the full results yet. I'll ask again when they call back.

I agree the CT scan is useful, and I will pay for it if necessary, I'm just worried that all this money is being thrown away with how Lulu's health fluctuates. I feel like it's one step improvement and two steps back. Maybe I'm just pessimistic, and I'd like to be more optimistic. I just can't tell enough right now.

Pulling out hair on paws
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Her "frozen stance" after food and meds
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User avatar
daveandtiff

Post   » Mon Aug 07, 2017 2:46 pm


Hairless on paws... referring to inside the carpus (wrist area)? Many pigs have areas of balding here. Not sure cause, someone here would. FWIW for what it's worth, AFAIK as far as I know. The most recent item a picky bunny I've been serving has gone for in a dish is app-ban critical care equally mixed with banana baby food and 3 tsp water add to these. I've ground oxbow veggie treats to add to critical care and juiced vegetation. One of these times might work. Otherwise syringe. You might be able to get hind nails if she is laying on side on pillow while giving her a treat she enjoys. The front can be done same way, usually when they're content and not expecting, then follow up quickly with nice treat and comforting touch and words or a blanket canopy or hay to go under to quickly forget the event. You don't have to do all at once. When mine are nervous I work on one or two at a time and follow their cues. If stressed, I stop.

NeoLeo87

Post   » Wed Aug 09, 2017 1:18 pm


Update: 8/9/17 - Stable right now, keeping close watch

Lulu had a vet visit yesterday. I wanted to check the reason for hair loss around her front legs. The doctor didn't notice any lice or mites, which is good. Weight is also stable (700~ grams), and behavior seems normal. The only thing he could suspect was using those parts of her front legs for grooming so often. He gave me a bottle of Silvion to spray on her patches, 2 times a day.

The doctor also suggested another look into physical therapy or acupuncture. We tried this before, but I found no benefits for Lulu, and in all 3 visits she hated it. But I'm willing to listen to a specialized vet in this field if they're willing to see Lulu for our next LSU visit.

Lulu's behavior and appearance have been normal the last few days. She is usually most active in the morning and late at night, though I have not seen her sprinting around her cage in the last couple days. She is also pretty lethargic through the daytime (spent mostly napping) but she is not as puffy as usual. Extra sleeping could be a result of Tramadol, and the doctor recommends they not be kept on NSAID for very long. LSU agrees, but they want her on Tramadol for 2 weeks until her next appointment. The doctor thinks gabapentin is the next likely choice for pain medicine.

Lulu was eager to eat this morning. She has been getting 2 cups of veggies and 10cc's of critical care a day (one set at morning, another at night), and she even bothered to nibble the pellet mash that I made. Alas, she still won't touch most of it. As for pellets, she still has trouble, but she's been eating them in greater volume than last week.

And finally, the UVB light came in. Meant to go 12-15 inches away from Lulu, 1 hour exposure a day. I'm not sure how to install this above her cage (see picture below). Anybody have ideas?

Dave&tiff, if you reference back to the images in the post, you will notice hair is missing on the front arm, above the paw. Thanks for the advice on the food, and nail trimming, but that probably works best with a normal and healthy guinea pig. Lulu is neither of those, and she does not like being touched. The best option for her case is to just let the vet staff clip them, which we did during her visit.

Lulu resting (normal looking?)
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UVB light
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