Heart problems vs pneumonia vs cancer: Nutmeg the ~1 year old skinny pig

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Cramer

Post   » Thu Nov 02, 2017 9:12 pm


Hi all,

So my Skinny pig Nutmeg lost about 100g of weight over the last week, and was noticeably less active and far easier to catch. I could place my hand right on her bottom, and she wouldn't even try to run. Usually she's very skittish and only allows nose rubs. Still eating and drinking, pooping a little bit less than I'd expect. Also, she always breaths with what I can best describe as a small wheeze, but she's had that since we've gotten her and the vet has never been concerned about it.

Anyhow, I took her to the vet and he did a full body x-ray. Her bowels loops were a bit dilated, so he diagnosed her with mild GI stasis and prescribed reglan. However, he noticed that her heart appeared to be enlarged, and that her trachea was deviated. He sent the images off to be read by a radiologist, and opted not to start her on any meds other than the reglan for now.

With the reglan she seemed to perk up a bit and seemed to be eating more, and appears to be forming more stool. However, her difficulty breathing is becoming more and more obvious. Two days later, the results came back. Per the radiologist, her heart cannot be visualized though her mediastinum is enlarged, she has severe hepatic (liver) enlargement, there are a lot of infiltrates in her lungs, and of course the obstructive gas pattern that's suggestive of stasis, bloat, or illeus. The radiologist stated that it's most likely neoplastic, but states it also could be severe infiltrative pneumonia with hepatitis or some other sort of inflammatory process. It also recommended ultrasound of the chest and abdomen, which is way out of my budget with this current vet.

I was expecting and hoping for her to be a heart pig...I was not expecting cancer of all things. The vet prescribed baytril in the hopes that at least the lung infiltrates are pneumonia, but that doesn't explain the liver enlargement.

I asked this vet if we could maybe try an ace inhibitor and a diuretic just to see if she would respond, and his response was "we don't know if those really work on guinea pigs." This comment set off a million red flags, so I scheduled an appointment with a proper exotics vet for tomorrow. This vet works WITH an exotics vet, but I just learned today that he actually isn't one himself.

I'll be posting the x-rays and radiology report later tonight. Nutmeg doesn't appear to be in pain...I tried metacam with her and her condition didn't change at all...but she's definitely having a lot of difficulty breathing. As a nurse (for humans) I can say that she appears to be breathing almost in an orthopenic position. She's using her accessory muscles to breathe, and she has to breathe for a few seconds in between taking bites of her food. I auscultated her chest, and didn't hear any murmurs or adventitious lung sounds, but then again I'm accustomed to listening to humans so I don't know for sure. Her wheezy sounds can only be heard from the outside, not when auscultating. I am surprised that she's still eating on her own, and her daily weights are currently maintaining though I have critical care ready in case I need it.

Her only history, per the previous owner, is that she "was a carrier for a respiratory disease that killed a lot of other Guineas, and she came from a breeder." Per the vet, that sounds like a load of bs, but that's all the info I have. Since I've had her, save for her slightly wheezy sounding breathing, she's been the picture of perfect health.

I'll keep everyone updated. I'll upload the radiology report and images as soon as I can get home to a computer. I don't think there's anything else I can do at this point other than keep that appointment tomorrow morning, but I always appreciate the input from the users on this site.

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Lynx
RESIST

Post   » Thu Nov 02, 2017 10:07 pm


You've been around for a while and it sounds like you've read over the heart page. I am sorry the vet was unwilling to give them a try, given what the radiologist had to say. I wish I had a medical background (even a human medical background - as you do) and could offer advice. I hope more knowledgeable members chime in.

Cramer

Post   » Thu Nov 02, 2017 11:01 pm


https://i.imgur.com/Km0W2Ec.jpg here's the radiology report. I won't be able to post the actual images tonight. Yeah, I have been around for a while! I never thought I'd be posting in this forum again this soon, especially not about my youngest pig.

I'm eagerly awaiting seeing the actual exotic vet tomorrow. I've been living out here in Orlando for about a year now, I haven't really needed to bring my pigs to the vet till this point (save for Nutmegs initial visit to the non-exotic when we first adopted her). He only sees exotics, and has a wealth of information on his website regarding guineas and other exotics. From all of the research I've been doing so far, it seems like ultrasound is the best next step. Theoretically it'll tell us if it's either heart disease or not. If it isn't heart disease then it's at the very least pneumonia, at worst cancer. Either way I'll be treating with antibiotics and possibly steroids if the vet feels they'll help. I don't think I'll subject her to a biopsy, because if it is cancer then I don't think it'll change the treatment.

That's all my thought process anyhow. I'll post again tomorrow after she's been seen.

bpatters
And got the T-shirt

Post   » Thu Nov 02, 2017 11:21 pm


Glad you've got a good vet. Do keep us posted.

Cramer

Post   » Fri Nov 03, 2017 2:16 pm


Just got home from the vet. I'm loving this vet so far, he's treating this all very aggressively. So, basically he believes that cancer is super unlikely with her being so young though acknowledges it's still possible. He's thinking she has a massive infection and he's a bit upset that they didn't even start her on the full dose of baytril. He also stated that recent research shows that reglan actually doesn't work well when given PO for guinea pigs, so he says it really isn't worth continuing that one.

He did some blood work (which she handled very well) which showed she has some dehydration and possible kidney injury, and slightly elevated liver enzymes but they aren't as bad as he thought they would be. Also, he now can hear some fluid in her lungs, and she's so gassy that he can literally squeeze the gas out of her. The kidney function means we won't be able to give metacam unfortunately.

Nutmeg is definitely eating less now and making smaller stools, so this isn't super shocking.

He doesn't want to do an ultrasound right now because he states that usually requires sedation, and sedation is not a good idea right now for her with her lungs the way they are. He says the most pressing issue is to treat the infection before looking into the heart. Basically her liver is so enlarged that it's pressing on everything, which is probably what's making it more difficult for her to breath and also compressing her gi tract.

We're getting her started on a gentamicin nebulizer, adding flagyl for the GI inflammation, milk thistle to help with immune health, cisapride to replace the reglan, adding cyproheptadine for appetite and to help with breathing, Lasix to help with the fluid on the lungs, and he's having me give 50ml of lactated ringers subQ per day since she's dehydrated and he doesn't want the Lasix to dehydrate her more.

He made it clear that we are very behind on the treatment right now, and it's very important to stay on top of the meds. She's young so she definitely has a shot. I'll keep everyone posted.

Bookfan
For the Love of Pigs

Post   » Fri Nov 03, 2017 3:00 pm


Good luck with her. Sounds like you're in a good position to give her great home care.

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Lynx
RESIST

Post   » Fri Nov 03, 2017 5:01 pm


From what I understand, cysapride and reglan treat motility differently. I think the reference forum might have Josephine's explanation.

If you can get any references on reglan not working as well, please share them. Many guinea pigs here have been prescribed reglan as a motility drug.

Cramer

Post   » Fri Nov 03, 2017 5:43 pm


So Nutmeg took a turn for the worst very quickly. Shortly after getting home I noticed that she was very cold, and she began to have more difficulty breathing. I tried to warm her up but it didn't help anything. She dragged herself to her pigloo, and just stopped breathing. I tried to give her rescue breaths, and she had a few more agonal breaths, but she never came back.

I understood that she had a pretty low chance of surviving this, but I didn't think she'd go so quickly. I think they forgot to warm the subq fluids before giving them, but I don't know for sure. By the way her breathing was getting more and more shallow I'm pretty sure she just went into respiratory failure.

The exotic vet is going to do a necropsy free of charge to figure out what exactly happened. I think the biggest issue is the delay in adequate care...the first (non exotic) vet didn't even realize that her liver was distended, and didn't get her started on baytril till day 4 after getting the x-ray images.

This sucks. I never thought she'd just go so quickly. She was my youngest pig and was otherwise healthy as far as I know anyhow.

Clint The Cuy

Post   » Fri Nov 03, 2017 5:54 pm


I am so sorry that you lost her.

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Lynx
RESIST

Post   » Fri Nov 03, 2017 7:38 pm


I am so sorry you lost her, Cramer. You have our sympathy.

Cramer

Post   » Fri Nov 03, 2017 8:35 pm


Just got the call from the vet. So, she had a very large mass growing on her mediastinum and pushing into her heart...plus of course her liver was massively enlarged. Her lungs, gut, and kidneys were actually mostly fine. The vet didn't want to call it cancer, and the cells he saw under the microscope weren't typical cancer cells, but it was definitely the cause of most of her symptoms. Liver issues still not explained, but the big takeaway is that there was no infection, so my other pigs are fine.

I'm heartbroken but kind of relieved. My other pigs are fine, and Nutmeg didn't seem to suffer until the very end...and that went very quick. If I would have gotten the ultrasound done it would have just told me that the mass was there, and honestly I'm not sure if I would have wanted her to go through surgery and whatnot because if it was cancer chances are it metastasized elsewhere anyhow. Not to mention, we may not have been able to do much regarding the liver.

She was a sweet pig, and I'm happy that we gave her a good life for the short amount of time that we had her.

bpatters
And got the T-shirt

Post   » Fri Nov 03, 2017 10:29 pm


I'm so sorry you lost her. What a heartbreaking experience.

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mmeadow
Supporter 2004-2017

Post   » Sat Nov 04, 2017 11:34 am


I'm sorry about Nutmeg.

Bookfan
For the Love of Pigs

Post   » Sun Nov 05, 2017 1:24 pm


I'm so sorry.

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