A stubborn URI case and questions

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APigNamedLafonda

Post   » Sun Jul 12, 2015 2:13 am


Hello everyone! My name is Renee and I am very grateful to have the resource that is guinea lynx. I have owned about a dozen pigs over the years and have been teching fulltime in equine hospitals for around 6 years, but I am limited in cavy medicine. All medicine interests me, I just don’t have as much experience with guinea pig medicine specifically and many of you do. I do have an established relationship with an exotics vet, but I also like to seek out information from educated individuals such as you. Bouncing information around has never hurt. This is another stubborn URI story, but I would greatly appreciate any feedback you may have. Thank you so much!

Pumpkin, a 4.5 yr-old american sow, began her URI saga earlier this year. She would have an occasional episode with audible labored breathing, but was otherwise BAR, eating, drinking, urinating, and defecating with a zest for life. No coughing or nasal discharge was present. The major warning for me was her drop from 1,194 grams of BW down to 1,134 grams over a few days. I took some radiographs of her lungs and trachea, a slight opacity was present in her ventral chin, but nothing else. On auscultation she had a very subtle intermittent “click” in her trachea. My exotics vet prescribed doxy for 14 days and scheduled a follow up with instructions to return with follow up radiographs. She improved as did her weight. Her radiographs were beautiful and her trachea and lung sounds were WNL, leading us to believe that the congestion in her dewlap on radiograph was inflammatory. The vet wondered if maybe she had a tooth root infection since initial radiographs showed some darkening at the base of 410 when compared to the follow up xrays. Her dentition is normal and no odors were ever present, but I believed it to be plausible.

Cut to 4 months later and we’re back again. Her labored breathing had returned with a drop in BW, but was still BAR and otherwise normal. Doc put her back on the doxy, but she made no improvement after a few days so the doxy was paired with enrofloxacin. That did the trick and she improved. I treated her twice daily for a month (with a probiotic) and waited one week post treatment for more radiographs. She had opacity in her lung fields… sigh. Thus the symptoms were soon to return. Vet wonders if it is allergies (which are unlikely he says), mycoplasma (does this occur in a GP?) that is suppressed by her antibiotics and the absence of them just causes the return, or something altogether different. The only other pets I have are one other healthy guinea pig and a cat. I am also now considering her heart after some reading on here. Doc said he has had gp patients on chronic antibiotic treatment for up to 6 months. My feeling is, to what end? To be where I am now, again?

At this point I’m going rogue and would like to submit my own culture and start nebulizing.

Of those of you that have had cultures done, how effective were they if no nasal discharge was present? How would you know that the culture would result in the actual organism and not a secondary contaminant since it isn’t sterile? I realize that the chance of a contaminant would be high regardless considering the area, but without a “substance” to culture, how efficacious were the chosen antibiotics based on culture results?

From what I have read, a lot of you have used acetylcysteine paired with saline and in some cases an antibiotic. I nebulize hospitalized foals with pneumonia with just straight acetylcysteine (200mg per Tx, usually every 4-8 hrs depending on severity). What is the dosage you have used to nebulize your guinea pigs and at what frequency? Also how much saline did you use and do you mix it with the acetylcysteine? And if an antibiotic will be introduced in the future, is that another separate nebulizer treatment each day?

Just for background purposes, I have been the home for these sassy sows for 3 years. Both of my pigs live in a 2x4 open c&c cage with the most dustless odor-free paper based bedding I could find. I would love to do the fleece, however I cannot keep up with it with a fulltime job. I’ve tried it in the past, but if a mere 8 hrs go by before I can clean it there’s poop everywhere, all over their feet and stuck between their little toes… no thanks. They eat a straightforward timothy based pellet, grass hay by the bale, and greens/fruits of course. Thank you again everyone!

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Lynx
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Post   » Sun Jul 12, 2015 6:38 am


I see you said you are also considering heart. This is where I would point you, given the experiences of people on the board. Reexamine the xrays for heart size and (sometimes visible) fluid around the heart.

gl/heart.html

Talishan
You can quote me

Post   » Mon Jul 13, 2015 1:42 am


Offhand -- for a well-set-in URI, doxy and baytril combo for up to a month or even longer if it's being tolerated well. You might also consider nebulizing this mixture; also consider a "pulse" treatment -- a few weeks on, a few weeks off. Well-set-in URI's can take weeks to fully resolve, and stopping the AB too soon ("too soon" having no set definition, but longer at least than the standard 2-week course) results in relapse.

I haven't used acetylcysteine so I can't comment as to delivery method, dose or efficacy.

Mycoplasma: not impossible but highly unlikely. Ditto on asthma/COPD-like conditions/allergies. Your vet is right. We had one girl with a chronic COPD-like condition who benefited from Ventipulmin (scaled way way way way WAY down), but she was very unusual.

At 4.5 years of age I'd definitely want to do a trial of benazepril (details on the heart page Lynx linked to). Pigs with heart compromise are much more likely to develop URI's and have a harder time shaking them once and for all; they will also often (not always, but often) have a higher-than-just-coincidental occurrence of dental problems.

I have had zero luck using fleece as a bedding, so you are not alone there. Wonderful stuff if you can make it work. I've never been able to.

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Lynx
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Post   » Mon Jul 13, 2015 9:08 am


Talishan, I added your advice on treating persistent URIs to the uri page (with a link back to your post).

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

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JadeMagpie

Post   » Mon Jul 13, 2015 10:20 am


Just wanted to chime in and say that I agree with Talishan - when I first got a guinea pig 4 years ago, I was very ignorant and bought from a pet store. They came with a terrible, stubborn URI that took months to treat, and it wasn't until the vet put us on a cocktail of antibiotics that it resolved.

We did a Baytril/Doxy combo, and later a ENROFLOXACIN & DOXYCYCLINE combo. It took literally months and months to treat, and about a month and a half once we found the right AB combo.

You can read the whole saga here: http://www.guinealynx.info/forums/viewtopic.php?t=61415&postdays=0&postorder=asc&start=0

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Lynx
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Post   » Mon Jul 13, 2015 10:25 am


JadeMagpie, for clarity, Baytril is the brand name of enrofloxacin (generic name). So you used the same drug combination for treatment.

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CavyHouse
Supporter in '11

Post   » Mon Jul 13, 2015 11:04 am


We had a piggy with a very stubborn URI that we thought we had cured a couple times only to have it return a short time after stopping treatment with TMS and Baytril. It wasn't until we tried a couple rounds of Azithromycin that it finally cleared up. Our vet was reluctant to try the Azithromycin at first because of lack of information about its side effects. But times tolerated quite well.

APigNamedLafonda

Post   » Mon Jul 13, 2015 10:41 pm


Thank you for all of your responses. The link to the heart info was helpful and interesting. I have been revisiting her radiographs, her cardiac silhouette is apparent, but I don’t think they are diagnostic enough to determine the presence of fluid. With my limited experience, her heart does not appear to be enlarged when compared to the xrays provided in the case studies. I do remember my vet making comments about her heart when reviewing the rads and he made no mention of abnormalities. It, to me, seems less than 60% of her thoracic cavity as indicated in the heart studies. There is a portion of her trachea that seems almost “pinched” where her lungs and trachea meet which I appreciated when we first took them. I do not know if that is normal or pathology and my vet did not seem concerned when he looked at them.

I have seen from people’s experiences that there aren’t always diagnostic cardiac findings on the radiographs and they have started an experimental trial of benazepril. Are there any adverse side effects that come with this treatment? I will consult with my vet and see if he thinks she is a good candidate. I would like to try and see if the nebulizing can bring her some relief. When I listen to her, the sounds always come from her trachea, not her lungs. And it is not consistent, not every breath produces a noise. Pneumonia cases that I have dealt with usually have a consistent harshness to their trachea, not one breath on and two breathes off. It does resemble the “hooting” that I keep reading about.

I would like to try to take more chest views focused on her heart. If you would feel comfortable looking at her existing views, I will post them for more opinions and ideas. I also talked to the doctors at work about maybe doing an u/s.

What is the longest anyone has had a pig on antibiotics? And were there successful results after something like 6 months? And were they cultured before beginning the prolonged trial?

Talishan
You can quote me

Post   » Tue Jul 14, 2015 12:19 am


Benazepril -- start with a low dose and ramp up. All but two of our heart pigs have stabilized at about half, or a little more, of the dose specified on our heart page.

The only real hazard with benazepril (an ACE inhibitor) is dropping blood pressure too low. If the piggy becomes lethargic, or even actually falls over on her side, reduce (or stop) the med. The dose can take some tweaking based on clinical sign. We've never had one to fall over, btw.

Post the rads and I'll be happy to look at them -- with the caveat that I am NOT a vet, nor tech, nor radiologist.

The tracheal 'pinch' you've noted is interesting. I wonder if in fact a bronchodilator might in fact help.

I agree with you that nebulization is a good next step.

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CavyHouse
Supporter in '11

Post   » Tue Jul 14, 2015 1:05 am


As for your question about what is the longest anyone has had a pig on antibiotics:

We had a guinea pig on 3 different antibiotics over the course of 9 months. But it wasn't for a respiratory issue. It was for a stubborn wound on the top of the foot. The guinea pig tolerated the antibiotics quite well but eventually needed the leg amputated.

APigNamedLafonda

Post   » Tue Jul 14, 2015 10:01 am


I tried to make the most of the scaled down xrays. I have more views, but I think these are the most appropriate for the heart. I will try to stretch her more in the future views. They cover the entire duration of this illness. She does have a mild hook to her upper incisors, but my vet and I decided to leave it alone as it doesn't affect her and would only put undue stress on her to float it. On intraoral exam, her molars are great.

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Lynx
RESIST

Post   » Tue Jul 14, 2015 3:55 pm


If I have the heart correctly identified, does look like it is not excessively large. The heart page quotes Dr. Beeder: "The heart should generally appear to be less than 60% of the total thoracic cavity in both lateral (side) and ventrodorsal (front) radiographic views. "

Talishan
You can quote me

Post   » Tue Jul 14, 2015 9:58 pm


Need to look on a real computer -- but one rule of thumb is can you count six or more ribs over the heart on radiograph. On that basis I'd say there's a possibility of slight enlargement that may benefit from a trial of benazepril based on clinical sign.

This is on my phone, though! Will take a better look at it later.

VERY VERY VERY WISE of you and your vet to leave her incisors alone if they are not causing her any problems.

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