The plan is for me to bring him in about an hour before we're ready to start. We'll do an exam then and give him his premeds and likely shave the site before we induce. Quick induction in the handy little induction chamber that my coworker put together and then a speedy cysto.
Standard procedure in my clinic is to monitor and record vitals every 5 minutes so we'll be doing at least that. I wish we had better/different equipment though, it's frustrating that we won't be able to have a SpO2 or even a doppler on him for monitoring as the ones we have simply won't fit him. It might end up being one of those fun surgeries where someone spend the entire time with a stethoscope on him unless I can come up with a way to make the doppler work for him. I'm working the evening shift so I'll be the one doing his post-op care which is comforting.
I thought I'd post the anesthetic protocol as it worked quite well for him. He was pretty stressed when I first brought him in so we opted to sedate pretty quickly. He was at 1.113 kg and we used Ketamine - 20 mg/kg, midazolam 0.5 mg/kg, butorphanol - 0.5 mg/kg, glycopyrolate - 0.02 mg/kg in a cocktail for a total of 0.3 mls given SQ. Once he was sufficiently sedated we took a lateral abdominal xray to assess where the bladder stone was located (and that it hadn't miraculously passed on its own). We then administered 20mL of warm LRS SQ and induced using a mask and isoflurane.
My vet removed the stone and took a sterile swab for a culture and sensitivity on the lining of the bladder. She then flushed the bladder with warm saline and passed a catheter from the bladder through the urethra followed by further flushing. She closed with subcuticular sutures and tissue glue. Mid surgery we gave him metacam and baytril by SQ injection. We were very careful to maintain his body temperature during surgery and post-op. Post-op we also did a follow up xray to make sure that no uroliths remained.
For aftercare he's been on buprenorphine, metacam and baytril. The first two days I used the buprenorphine every 8 hours and then backed off to twice daily. The metacam and baytril were both SID. He began eating on his own that evening, although not enough to maintain his own body weight so I supplemented with CC. By Wednesday afternoon he was begging for veggies. He's still not eating quite enough to maintain his weight so I'm feeding ~30 mL of CC a day.
His culture came back today with no growth after 72 hours so we've stopped the baytril. I'm going to try backing off on the buprenorphine today as he seems a bit sedate. His incision looks fantastic and he's been very vocal in his demands for more veggies and fresh hay. Honestly, I think he's enjoying the extra pampering at this point.
Does anyone have advice on how best to taper off his pain meds? Or even when to start?
- You can quote me
I've had good success tapering the opiate down while ramping the NSAID up, then ceasing the opiate, then tapering and eventually ceasing the NSAID. Visualize it sorta like two overlapping roller coaster humps, if that makes any sense at all.
Over two weeks he lost 150g putting him at 1kg as opposed to his healthy 1.15kg self. He is still eating just not enough. He's not eager to see his veggies but he will eventually eat them. Same deal for hay and pellets. I just got an order of orchard grass in that he seems a tiny bit more interested in but nowhere near normal. I've been supplementing with CC mixed with a bit of baby food to keep his interest up. He's been eating most of that with minimal syringe feeding from me. I think it's guinea pig crack.
The vet could not get blood from him nor a decent urine sample. The sample Timothy provided in the kennel had no blood, the occasional crystal and a normal USG. His teeth looked wonderful and the vet did actually have the correct equipment to get a good look. His x-ray machine was down and he's still waiting on parts. This is the northern hell part of the equation. The vet didn't seem to think he'd have more luck getting a blood sample at a later date, I think I may be the only person he's met who wanted bloodwork done on her guinea pig.
No palpable masses or guarding, lungs sound great, no eye discharge, no pained noises when eliminating and no murmur heard. Basically, we've got anorexia and the history of the occasional cough. I think I got complacent with typically hearing him cough while eating and I've now caught him coughing at other times. It's rare but it is happening. The good news is that this vet is willing to give me heart meds just in case, mostly because he has no idea what is happening. He'll be calling it in today to the one compounding pharmacy available since they're not open on Sundays nor was the vet. I just somehow managed to catch him in the office catching up on paperwork. I miss my old vet.
- You can quote me
Having said that -- I still suspect teeth which means x-ray parts needed. Any idea when they will be in?
Without reading back, how old is Timothy?
The heart med alone may do the trick. Please keep us posted.
The x-ray parts should be in today, I'm going to call once they open. They don't have dental x-rays nor does any clinic in the surrounding area that is willing to see guinea pigs. I'm disturbed that they just flat our refuse to see them, the idea of having an emergency terrifies me. True, the good ER clinic where I lived before was an hour away but they were GOOD and fully equipped for everything.
I missed the vet's call yesterday but he mentioned he was calling the script into the compounding pharmacy. I missed the pharmacy by about 5 minutes. This morning I'll figure out what we got and negotiate if need be.
We started on the enalapril but I'd love some input on dosage. The reference the vet went with was 0.5 mg every other day for a roughly 1kg pig. I'm pretty sure that I did 0.25mg SID for Alfalfa but I can't find it in my records. Any thoughts?
The past two days I've noticed some calcium grit on his fleece. No pain when peeing, no visible blood in the urine. He's getting unlimited grassy hay, limited Oxbow pellets and veggies in a 2:1 Ca:P ratio. I'm working on lowering that to a 1.5:1 ratio. He's also getting some critical care offered daily because he loves it and I want to up his weight a bit more. The only real change to his diet has been the compounded enalapril.
Does anyone have any information on calcium content in compounded meds? I'm waiting for a callback from my vet and from the pharmacist that does the compounding. We've tentatively scheduled a vet visit for tomorrow. If we get heavy snows I might not be able to make it as I don't have winter tires installed yet and I'm not buying tires until I find out what Timothy will need. Catch-22s are always good fun. In case of snow I'm hoping to convince a local vet to see him, do some rads and a UA and forward to my other vet.
Right now I'm thinking rads to rule out stones and take a look at what we may be looking at in terms of sludge. I'm upping water intake via syringe and will likely be asking for SQ fluid supplies to help flush out his system. He hasn't increased water intake on his own but there wasn't a noticeable difference when he had his stone. My previous vet didn't see the point to adding polycitra but I'm going to talk to this vet and see if he's will to try. Help?
- And got the T-shirt
Since you're in Canada, you can't get KM at the moment, but I wonder if a switch to another kind of pellet with a different calcium compound in it might help.
He's lost 20 grams in about a week and had reduced appetite so we were off to the vet again today. I managed to track the one in town down that I had worked with at a previous job. He has next to no experience with guinea pigs but was thrilled to have permission to do more than euthanize or toss random ABs at one.
Teeth looked good, examined with sedation. Rads looked good, no stones and no fluid. Were able to do a mini panel in house and rule out diabetes and kidney disease. Liver values are waaay out of whack though, I'll get the exact values when I speak to the vet this evening since I forgot to record them at the clinic. The vet is thinking primary liver disease of some sort based upon the numbers. We don't have an U/S and I'm not willing to do a liver biopsy on him at this time.
Plan is to correct his mild dehydration and then continue with some SQ fluids with added B12 on a regular basis. His temp was normal and I don't want to toss ABs at him when there's no sign of an infection. I'm going to suggest denamarin or separate SAM-e and milk thistle supplements, I think the vet will be supportive. Anyone have actual dosages? I can't seem to find them anywhere.
- You can quote me
We tried milk thistle on one of ours, to no avail but that doesn't mean it wouldn't help your pig. If your vet can look on VIN I think there are SAM-e dosages on there at the very least. I think. I don't still have the dosages, otherwise would post them.
With regular CC (syringe first few days then switching to eating a slurry with a bit of baby food), SQ fluids, B vitamins and SAM-e Timothy stabilized for a bit. His weight went up to 975g, it had dipped down to 900 at his worst. Healthy, happy, young Timothy was 1.1kg but had steadily lost with first his cystotomy then heart disease. We never quite managed to put all the weight back on but he had been at an okay weight, a bit thin but doable.
On the third I noticed that he'd begun to lose weight, dropping to 950g overnight. I began pushing more critical care and booked the soonest vet appointment I could get (today the 4th).
Yesterday he was depressed and refused his veggies. I began syringe feeding and found, as the night progressed that he was having difficulties swallowing. He was drooling and occasionally gagging. By 4 am he appeared painful in that he was grinding his molars, sitting hunched up and occasionally rocking back and forth. The drooling was worse and he was spitting up fluid, I'd stopped even trying to get CC in him a few hours before. Neither vet in town called me back despite repeated calls on my part.
At 4 I cracked and did a bad thing. He was painful and I couldn't get a vet and I panicked a little bit. I gave him some buprenorphine that I had laying around even though I know it's not indicated for use in those with liver disease, I don't think it's okay with the heart disease either. At that point in time I didn't feel that we had much to lose and I was hoping to give him a bit of comfort while waiting for the vet to call. Within half and hour he was, dare I say it, perky. He got grumpy with me cuddling him then went into his cage and began eating some hay. I provided veggies and CC on a dish and he devoured both. This morning he's had a bit of veggies, more CC and eaten a bunch of hay. He LOUDLY wheeked when I opened the fridge for coffee cream.
We have an appointment today that I had assumed would be euthanasia. Now I'm not so sure. Obviously the buprenorphine isn't something that we can continue but I'm wondering what is going on? I read that in humans it's used to treat conditions in which a patient has difficulty swallowing so I'm thinking that's where it's being helpful more than anything.
The more I've been feeling his neck the more it feels like it might be a bit edematous, it's definitely not a standard fatty pig dewlap feel and it's not the same as the just skin feeling of an emaciated pig. His abdomen feels okay but I'm not exactly a rockstar in that department. He's pale but his CRT is less than 2 seconds. I heard some hooting this morning when we were hanging out but he was happily eating some cucumber in between. Could this be a worsening of his heart disease accounting for some of the signs? The pale mm, hooting and lethargy all make me think heart but, honestly, at this point it could be pretty much anything going on him. Teeth are another obvious one.
Now, I'm a bit stuck as to what to do. Obviously, there's a lot going on with him and I don't want to prolong his life out of a selfish desire to hold onto him. On the other hand, if this is something manageable then I would hate to not give it a try. I'm leaning towards doing another x-ray to see if there's something that points to heart that we might be able to try treating more aggressively. If it's something like a pain issue associated with another bladder stone then we'll euthanize, I think it would be kinder than having any vet here perform surgery on him.
Does this seem reasonable? Rads to see if it's something obvious with his heart, or something else obvious like a bladder stone. If nothing is clealy obvious in the rads then I'd proceed to anesthetizing him with iso then have the vet thoroughly examine his teeth, if that's not the problem then we'd euthanize. It feels so cold blooded to lay it out like this but I think it's my best plan. Please tell me someone has a better one?
Sorry I can't be of more help.