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Emergency-- meds and dosages for bloat
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7/9/2007, 9:19 am
chii   Link to Post Go to the top of this page  
chii
Always in my Heart


Four Time Supporter

I have a rescue pig with bloat-- I'm at the clinic I work at and just snapped an x-ray to confirm. No vets will be here for at least another 45 minutes. I read that I can give Cisapride... anyone know the dosage on this? How is it usually administered? Any other meds that may help? He weighs about 1 kilo.
7/9/2007, 9:37 am
Lynx   Link to Post Go to the top of this page  
Lynx
Heartless Dictator




It's in the guide under motility drugs (I'm pretty sure).
7/9/2007, 10:40 am
TX Rustlers   Link to Post Go to the top of this page  
TX Rustlers





Reglan (Metroclopromide) sub q 0.1cc and pain meds Bupronex
7/9/2007, 1:38 pm
rshevin   Link to Post Go to the top of this page  
rshevin





My pig has also received Cisapride orally at approximately 0.1cc/kg q12h although concentration isn't noted on the bottle. He receives a big sub-Q of lactated ringers at the vets and some thing injectable that they never tell me what it is and I was too frazzeled to ask. I always combine this with simethicone 0.2cc 2-4 times a day.
7/9/2007, 3:55 pm
chii   Link to Post Go to the top of this page  
chii
Always in my Heart


Four Time Supporter

After speaking with several exotics vets in our area (my usual vet of choice is out of town for a week!), we used the ultrasound and tapped his stomach and cecum, pulling off 200cc of gas. It appears that gas is reforming in the stomach as of the last x-ray I took about half an hour ago, but he was comfortable enough after we removed the gas to eat a little hay on his own. I suspect we'll have to tap him again though.

We started him on Reglan 1mg q3-4h and Simethicone 1cc (yes 1.0) q8h. I've given him small (10cc) doses of LRS, but I'm hesitant to do more than that at a time as I've had suspicions that he may be a heart pig. We're also giving him Burprenex q6h.

The vet I spoke to seemed very knowledgable... we discussed the risks of the various treatment options, but I agreed with her that we should pursue the most aggressive treatment possible as quickly as possible.

He seems to be stable right now, but our biggest concern is torsion. Our vets aren't experienced reading exotics radiographs. I'm encouraged that he's eating some although it's only a little. If he's still stable by the end of the day, I'll be sending out his x-rays to the radiologist with the labwork.

Thanks for all the responses... by the by, the piggy is Perriwig. Please keep him in your thoughts.
7/9/2007, 4:08 pm
cutemomomi   Link to Post Go to the top of this page  
cutemomomi
I didn't do it!


Obey My Authority

Please feel better Perriwig, we send you ninja vibes and good thought.
7/9/2007, 7:29 pm
Talishan   Link to Post Go to the top of this page  
Talishan
Cleaning Lady


You can quote me

This is what my veterinarian has prepared for rabbits. Modify for a cavy:

***********************************

Normalize body temperature FIRST be sure not to overheat!

Administer Analgesics for Pain Relief
Flunixin meglumine (Banamine) for up to 3 days usage
1-3 mg/kg IM or SC every 12 to 24 hrs
Contraindicated in animals with kidney disease
Sulfasalazine (500 mg tablets)
1/8 to crushed tablet per rabbit every 8 to 12 hours
Butorphanol

Subcutaneous fluids (warmed LRS) - 100 ml/kg/day divided every 8 hours

Restore Gastrointestinal Motility
Cisapride given at 1- 1.5 mg/kg every 12 hours
Metoclopramide given at 1 1.5 mg/kg every 12 hours
(May work best using both medications in combination)

AVOID in cases of TRUE OBSTRUCTION

Stimulate appetite
Vitamin B Complex added to the fluids
Cyproheptadine 4mg tablets or 1 mg/ml oral liquid
Give 1 mg per 4-6 lb rabbit every 12 hours

Prevent/Treat Enterotoxemia
Questran (Cholestyramine) 2 grams suspended in 20
ml water every 8 hrs PO
Antibiotics only if indicated (Trimethoprim-Sulfa 48 mg/ml
dosed at 30 mg/kg every 12 hr)

Syringe feed if not eating - liquid important to soften/rehydrate stomach contents
Oral fluids (no sugar) 10-20 mls every 8 hours
Papain and Bromelain powders (health food stores) in
pedialyte
4-6 Tbsp. softened rabbit pellets soaked in Pedialyte
Combine with vegetable baby food
Blend ingredients in blender and feed with syringe
First day (rabbit) - feed 20 ml every 6 hours (4X per day)
- increase to 30 to 40 mls every 6 hrs until eating well on
own
Vegetable baby food - 15 ml/kg every 6 hours

Critical Care for Herbivores (Oxbow Pet Products) may
also be utilized

Fresh, wet, leafy greens 4 cups per 5 lbs of rabbit daily
Kale, mint, basil, dill, cilantro, tarragon, sage, fennel,
parsley
Snip ends off stems and wave under nose, place in
mouth, or tap face

Pediatric gas relief simethicone liquid ( 20 mg / 0.3 ml ) to reduce gas pain
1 to 2 ml once an hour for 2-3 doses

Exercise can help get the gastrointestinal tract moving again

Administer gentle abdominal massage (head down, rear up) several times daily

***********************************

I would add gentle sessions on a massage pad or muscle relief vibrating pad, to tolerance.

Good luck with him. Please let us know how he's doing.
7/9/2007, 7:32 pm
amy m guinea   Link to Post Go to the top of this page  
amy m guinea





I'm thinking of Perriwig. I went through the same thing recently, although it sounds as if your piggie is having a worse time of it. She was on Reglan and Metacam for 5 days. I gave some Simethicone, but not regularly.

She has recovered but for some reason will not eat pellets, but has gained weight due to CC mixed in with pumpkin.

Is he eating hay only? My vet had Jenna on hay only for almost a week (and hand feeding CC).
7/10/2007, 1:40 am
chii   Link to Post Go to the top of this page  
chii
Always in my Heart


Four Time Supporter

First of all, thank you all for the kind comments, especially Talishan for the detailed treatment regimen info.

Perriwig is still hanging in there. I took x-rays on him throughout the day and by late afternoon, he appeared to have a significant buildup of gas again. We decided to tap him again. This time we only drew off 45cc, which was encouraging compared to the 200 we drew off earlier. I really thought based on the x-rays that we'd get much more. I did follow-up x-rays and there was still one large bubble of gas around his cecum, but we decided to hold off on tapping him again. About 1.5 hours later, I did another set of x-rays and they look the most normal of any so far. The large bubble of gas appeared to be gone, though there is still a lot of gas in his intestines and some in his stomach along with fluid. We're unsure if he has stomach torsion or not, but sent off the radiographs to the radiologist (with a STAT request) for interpretation. I should have the results back early tomorrow.

I'm now just trying to keep him stable tonight. He IS still eating, albeit very small amounts and only of hay. I didn't have pellets at the clinic today, but tonight he is back in his cage with hay and pellets. I'm hoping the pellets will entice him to try to eat more. I'm encouraged that he's eating at all since I would suspect that if he had torsion, he wouldn't feel like eating. Perriwig is very big on veggies and it makes me sad that I can't give him some... I think it would make him eat more, but we can't risk it. At this point, I have not force fed any at all, but I may gently offer Critical Care tonight with a syringe and see if he's interested.

Does anyone think that pellets are NOT a good idea at this point? From what I know, I think they're OK, but if there's any contradiction, I'll remove them.

At the advice of the wonderful exotics vet who helped me over the phone today, I've been keeping Perriwig pretty well drugged on Buprenex. This particular vet feels that good pain control is critical in treating cases of bloat, though I feel like he's more sedate and less likely to eat when it kicks in (this I decided just from observation).

My vets have made it extremely clear that Perriwig's prognosis is still very grim, but that being said, I can't help but be impressed by this little pig. Even at the worst of it, he was hanging in there, and when relieved of some of the gas, he is eating and moving around and enjoying being petted like always. He feels so thin now compared to his normal self, it's scary, but he is FIGHTING. As long as he keeps fighting, I will too. My vets talked with me earlier today about how far I wanted to pursue treatment and how they suspect torsion, but with none of them being exotics vets and me having seen how he's still fighting and eating, I'm not willing to give up yet.

If he does have torsion, he will not be able to survive surgery and I'll have to put him to sleep, but as of now, my gut says it's not torsion. What pig with torsion would will move around and eat? He's not eating large amounts, but he IS eating. And he's still alive. That says a lot to me.

If Perriwig pulls through this, what special care/dietary needs will he require? I've read that bloat can tend to recur. Should he have a special diet or other special care to prevent future occurrences? Or is it a freak random thing that just happens? I've never had a pig with bloat survive, so I have no idea what to do if we get through this critical phase. I need advice and lots of it. At this point, if he does survive and requires special care, he'll probably be permanently adopted into the rescue as a sanctuary pig. He's an old man... and he's the sweetest pig. I don't want a random episode of bloat to end his life.

Hang in there, Pig-Wiggle. You've come this far...
7/10/2007, 6:07 am
maremma   Link to Post Go to the top of this page  
maremma





Did you send ALL the xrays to the person who can read them most accurately? If he originally had a torsion the wise decision to remove all the gas may have actually relaxed him enough to have it move back to the correct position and hopefully in time that no permanant damage was done.
As shocking as it was to me, my Sweetpea actually kept right on eating her hay until the moment I pulled her from her pen to rush her to the vet with severe bloat! Her stomache had turned inside of itself as well. Apparently torsion doesn't always mean total refusal to eat!

She had to have the gas removed from her too. I chose to have her sedated and a tube put down her throat to get it out. The vet got all the gas out and re-xrayed her to see if the stomache relaxed back into normal position after the procedure. Thank God it did and again thank God we caught it in time that it did not cause necrosis. She was also given a grim prognosis even after the gas was off and her stomache returned to normal. (She is still with me 1 year and 8 months later so do not give up hope!)

Please do feed him small and very frequent amounts of criti care mixed with pure pumpkin with lots of acidophilus or benebac mixed in it along with all his fluids. (I just very recently discovered that feeding her pumpkin with her criti care snacks is a tremendous help for her gas)
Do not allow him to eat to much at one time so he has fairly even amounts of food moving through his system at one time but not so much that it slows him down. You sure do not want stasis setting in. Fruits are an absolute no and very very few veggies are safe for Sweetpea. I am pretty sure the same is true for any guinea pig that has bloated.

I have discovered that Sweetpea has a whole lot more trouble if she doesn't keep eating small amounts all day long. If she woofs something down really fast she will surly be sitting on her massager or if she stays laying in bed to long. Keeping them moving is very very important once you rule out torsions.

Please be very careful about giving him so much simethicone. It doesn't help them toot out gas. It works by causing smaller gas bubbles to form into one larger one. That of course can be deadly to a bloat guinea. If the gas bubble is to big he sure can't toot it out, especially if it is stuck behind a lot of food working its way through his system. (thus why smaller more frequent food is better for them)

If Sweetpea has a tiny amount of gas it helps her but only if I give it and then use the massager to help it help her toot it out. If she already has to much gas it is not given to her because it makes everything far worse.

I really pray you are mistaken about his heart so he can safely have the reglan and cisapride. Sweetpea also has a heart condition and cannot have those type meds because of it.

I ma praying for your little man.
7/10/2007, 7:53 am
sef1268   Link to Post Go to the top of this page  
sef1268
Pig-Headed




Talishan,
Maybe just a little too early for me yet, but what were you referring to when you said, "AVOID in cases of TRUE OBSTRUCTION"?

I want to print out this info and keep it handy.
7/10/2007, 1:57 pm
JudiL[MetroGPIGRescue]   Link to Post Go to the top of this page  
JudiL[MetroGPIGRescue]



Poop Obsessed

Talishan, your vet has a wonderful plan. It sure is all-inclusive. It sounds like it should be written up for the 'references and first-hand accounts' section.

"Maybe just a little too early for me yet, but what were you referring to when you said, "AVOID in cases of TRUE OBSTRUCTION"? "

Sef, she was referring to the Cisapride and the metoclopramide. They are both gut motility drugs and if there is a true blockage in the gastrointestinal tract, the drugs could have devastating effects.
7/10/2007, 2:03 pm
amy m guinea   Link to Post Go to the top of this page  
amy m guinea





I'm also interested in what special diet and care a post-bloat pigs requires. My Jenna is now doing find on a very small amount (1/8) cup of non-gassy greens and sliver of carrot 2x/day, unlimited timothy hay, and 3 feedings a day of canned pumpkin with Critical Care mixed in. This works for her, but I don't know if it would work on a more serious case.

I'm hoping your little guy gets well soon! He sounds like a fighter.

Maremma and I agree on the CC/pumpkin mixture! Perhaps I should feed more frequent and smaller portions too, it makes sense.

This experience has made me extra careful with what I feed my other pigs, I think in the past I fed them too many greens and chard. Just my thoughts.
7/10/2007, 4:58 pm
Talishan   Link to Post Go to the top of this page  
Talishan
Cleaning Lady


You can quote me

JudiL is 100% right. "Avoid in cases of true obstruction" means take an x-ray and if a true blockage is shown, don't do motility drugs and forcefeeding. They can have truly devastating consequences.

Chii, how old is Perriwig? In our experience, older animals (4+) benefit from more frequent, smaller feedings as Maremma mentions, and smaller vegetable pieces at one time, given more often.

I don't think torsion and Sweetpea's 'telescoping' (our vet's lay term for a long, unpronounceable medical word) are exactly the same condition. The net effect is similar, though, as I understand it.

I'd seriously doubt Perriwig has experienced a torsion. As I understand it, it is hideously painful and nearly always, very quickly, fatal.

How is he doing today?

My vet's protocol can certainly be listed in reference or linked to, but I would feel better if Josephine or someone else competent to do so (read: not me) would review it and modify it specifically for a cavy, so that someone reading it in a panic and in a hurry doesn't have to think about modification.

This treatment is for hypomotility/ileus -- that is, stasis. Stasis and bloat are not exactly the same thing. A pig can be bloated and not experience stasis, although a lot (most?) of bloat cases do, unfortunately, go into stasis.
7/10/2007, 11:14 pm
sef1268   Link to Post Go to the top of this page  
sef1268
Pig-Headed




Got it [concerning the motility drug question], thanks.

A vet tipped me about pumpkin back when Zachary was having so much trouble with AB's and was really gassy and producing funky poops. He loved the stuff, and the moisture + fiber really seemed to have a positive effect.
7/11/2007, 1:17 am
chii   Link to Post Go to the top of this page  
chii
Always in my Heart


Four Time Supporter

So sorry, guys... I was up every couple of hours last night with Perriwig and was then at work all day today. I'm now sufficiently exhausted. Thank you ALL again for all of the advice and kind words.

Perriwig seemed much better last night when I got up to do his 2am meds. He was munching on food. At 5am, he was still eating away and fled from me into his house when I went to get him out for his injection. He also felt well enough to scream bloody murder. At that same time, I noticed POOPS in his cage!!!! I took him to work at 8am and took a new x-ray, which while still showing extremely small gassy areas in the intestines, looked great! Perriwig was eating away and PISSED that we kept bothering him. Although his weight is still down, he looked more filled out just overnight, probably because he was finally getting food in his system. I think he'll be on his way back up to normal very soon.

He looks bright and alert today and is acting like nothing happened at all. It truly blows my mind to see how he is today when he seemed so close to death yesterday. My vets were all prepared to console me when I came in this morning and were utterly shocked to hear of his amazing recovery.

I called the wonderful vet who consulted with me and gave me the advice on how to treat him and asked her what to do next. She says to continue his treatment regimen for five days. (My god, five days and nights of meds every 3 hours... it reminds me of when Aya was sick... I'll be a zombie for sure.) She gave me diet, etc. recommendations for after that. For now, he should stay on only hay and pellets. Once these first few critical days are over, we can introduce veggies such as lettuces and parsley. As someone else stated, he should never have fruits again nor any veggies that aren't staples. The nice vet lady was SO glad to hear that Perriwig is doing so much better and I thanked her profusely for taking the time to talk to me. I truly 100% believe that her advice saved his life. Had she not spoken with me yesterday, I would have followed the almost completely contradictory advice of another exotics vet whom I'd spoken with earlier in the day, though that vet has never been one I really trusted. I just hadn't been able to get any advice from another even semi-knowledgeable vet at that point.

So all of that being said, I would like to say that I HIGHLY, highly recommend Dr. Elizabeth Kamaka in Kirkland, WA based on her wonderful expertise and advice (now demonstrated in practice) and her kindness and willingness to help someone in need, even though I had never met her or used her practice in the past. She was so extremely helpful and sympathetic and kind. Even though she is a ways away, I will consider her for future care for my piggies.

Anyway, enough praising for now. I'm just SO incredibly thrilled with how Perriwig is doing. I've never seen such a sick pig that was so willing to live and that recovered so amazingly quickly and completely. At least in appearance, that is. We will continue his treatment, but I feel certain now that he will be OK. Any pig that can pull through what he went through over the last 48 hours can certainly handle the recovery. It must have taken so much heart and life to live through his experience. Now it's almost like he's forgotten what happened. I almost feel guilty when I go to give him his injections and he cries, but I just remind him that a little needle stick is nothing compared to what he's overcome.

I sound like I'm writing an inspirational book. I'm exhausted and delirious. More updates tomorrow.
7/11/2007, 1:31 am
chii   Link to Post Go to the top of this page  
chii
Always in my Heart


Four Time Supporter

PS- I have a series of radiographs taken beginning yesterday morning, throughout the day yesterday (a series of about 5 or 6 at various times and points throughout treatment), and a recheck this morning. Most of these are at the radiologist's office, but once they come back, I'll try to get decent digital photos of them and write up notes regarding his status at those times and the treatments we did in between. I'm hoping they're something that Lynx may be able to use on the site. I'll also include the radiology report.
7/11/2007, 8:43 am
Lynx   Link to Post Go to the top of this page  
Lynx
Heartless Dictator




We will definitely be able to use your experiences. Bloat is one of the most difficult conditions to treat and requires immediate attention.

I hope he continues to improve. An adjustment of Talishan's advice to guinea pigs would also be valuable.

For now I will add a link to this thread from the emergency page in the guide.
7/11/2007, 12:07 pm
rshevin   Link to Post Go to the top of this page  
rshevin





Yes, I would love to see the radiographs personally. I have a pig with a sensitive tummy who's been on cisapride twice in his life. Luckily I've learned mostly how to control his gas by controlling his diet and he's never ended up with true bloat (knock on wood) but being the nerd that I am, I'm interested in learning.
7/11/2007, 12:15 pm
sef1268   Link to Post Go to the top of this page  
sef1268
Pig-Headed




So glad to hear that Perriwig is doing better. What did Dr. K originally recommend, other than the Buprenex? Sounds like she is a great resource to have in an emergency.
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-22F = -30C
-4F = -20C
14F = -10C

32F = 0C
41F = 5C
50F = 10C
59F = 15C
68F = 20C
77F = 25C
86F = 30C
95F = 35C

98.6F = 37C
100.4F = 38C
102.2F = 39C
104.0F = 40C
105.8F = 41C
107.6F = 42C
109.4F = 43C
111.2F = 44C
113.0F = 45C
114.8F = 46C
116.6F = 47C
118.4F = 48C
120.2F = 49C
122.0F = 50C


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