Mavis - Currently having a stroke/heart attack?

User avatar
Tofu

Post   » Fri Nov 06, 2020 9:57 pm


Mavis is a ~6.5yr old intact female. She was in good health up until about a month ago when I noticed she was having trouble breathing. I took her to an emergency vet immediately and they kept her overnight on oxygen, took x-rays, did bloodwork. X-rays revealed extensive arthritis in the spine and hips, they had concerns about her heart and lungs but told me the x-rays weren't really clear enough to say anything other than it looked like she had some fluid in her lungs. Also remarked that her esophagus was very high. (I've requested a copy of these x-rays but don't have them yet.) They gave her pain meds for the arthritis and said her breathing was better controlled with pain meds so they thought perhaps this was all pain related due to the arthritis. We did a course of Baytril as well for any potential respiratory infection. They sent her home to me and she's been on Metacam 2x a day since then. She seemed to be doing great.

Tuesday my other pigs were kinda harassing her a bit (last couple weeks there's been a lot of dominance play in the herd and I was starting to wonder if it was starting to get a bit abnormal) when I look in and she's got nystagmus, head tilt, and a left side weakness. I call my regular vet and they say they can't take her, and to go back to the emergency vet. I go immediately, it's a ~40min drive. When we arrive and I hand her off (can't go inside of course due to COVID-19 procedures), she appears alert, coordinated, sitting upright. No nystagmus. They keep her for a couple hours, do more x-rays, attempt more bloodwork but she's too stressed out. X-rays show the same thing from a month ago: arthritis, maybe fluid in the lungs but it's not clear, high esophagus. They want to keep her overnight to the tune of $1900. At this point I'm starting to think heart issues, and one of the vets suggests maybe the neurological symptoms could be because she briefly did not have enough oxygen going to her brain. Their best guess at this point is congestive heart failure, and they prescribe lasix and they give her an injection of it at the ER. I ask about an ACE inhibitor but they won't prescribe it, instead they say I'll need to follow up with my that vet. They send me home with antibiotics as well. She seems very tired the whole rest of the day and I keep her separated from the rest of the herd. By the next day she seems almost been to normal. We continue with the AB, lasix, and the Metacam for 4 days and she seems to be doing great, breathing is generally calm most of the time. I requested a copy of the records and received them but am still waiting on the x-rays.

Now it's Friday night and I got her out of the cage at 8pm for the last round of meds for the day. I give her 3 meds and a piece of cucumber as a reward. She is totally fine when I grabbed her from the cage and within 2min I can see something is wrong. She has left side weakness. As time goes on she has a head tilt and nystagmus as well. It's worse than the first time. I'm right now sitting here with her on my lap in a towel. For a while she was trying to turn herself around and around on circles. It's heartbreaking to watch.

It's now about an hour and 30min since this "attack" began. She has recovered a bit, ate a big piece of lettuce, but is breathing pretty fast. The nystagmus has improved or is mostly gone, she's sitting up, no head tilt. I've been trying to get my regular vet on the phone since Tuesday to discuss her most recent health issues and now obviously I'm going to do whatever the hell I can to talk to them tomorrow since she's obviously had two strokes? heart attacks? in a week.

Without the x-rays obviously I don't have a lot of good raw data to share here. Does any of this make sense? Been reading up a lot on heart pigs and I'd like to get Mavis on an ACE inhibitor to see if that would help but how can I prevent whatever is happening to her right now? Am I even going on the right direction?

Here she is this past Tuesday after coming home from the ER:
Image

User avatar
Lynx
Celebrate!!!

Post   » Fri Nov 06, 2020 10:56 pm


Not familiar with nystagmus. It seems to be involuntary eye movement?

I can't offer any advice but hope you are able to resolve this. Separating her from the other guinea pigs for the time being sounds like a wise move.

User avatar
Tofu

Post   » Fri Nov 06, 2020 11:05 pm


Yes, rapid back and forth twitching of the eyes which seems to be involuntary.

I've got her back in the cage now. She's eating a couple snacks but still seems to be weak/paralyzed on one side and acts stressed. Definitely seems like a stroke. Not sure there is anything else I can do for the poor girl this evening. :(

Lisa12

Post   » Sat Nov 07, 2020 1:20 am


What about vestibular syndrome?
But the thing is symptoms goes away in three days ...and little head tilt stays permanently.
They say to me if the dog gets better in three days its vestibular if not its a stroke-cats can get that, too..probably pigs, too?

Left-right eye movmenet and head tilt on right its better than if eyes go up and down cause that means its central( brain is affected)

User avatar
Sef
I dissent.

Post   » Sat Nov 07, 2020 7:15 am


I'm so sorry about Mavis. My first thought, reading this, was something going on with the inner ear. I know she was given Baytril, but possibly an infection going on that hasn't responded to the antibiotcs?

Please let us know what the vet has to say.

User avatar
Tofu

Post   » Sat Nov 07, 2020 7:37 am


It's now about 12 hours since her "attack" and Mavis seems to be almost entirely recovered. She is eating hay and drinking water on her own, and I just gave her a nice sized piece of lettuce which she gobbled up. If anything is lingering I think she's acting much more fearful than normal. As I have no clue what actually brought this on I'm really kind of worried to give her meds at 8am in case that's what triggered this last night. :(

Just wanted to share the vet notes from the ER visit on Tuesday:


Pet’s Name: Mavis Age: 6.5 yrs Sex: IF Breed: Guinea Pig Wt: 0.97 kg
Color: Black Marking: Solid

HISTORY:
Mavis presented for neurologic issues. Owner states that yesterday Mavis was fine but this morning she
noticed a head tilt, nystagmus, and some left side paralysis. She was still responsive and eating some
greens that the owner offered. She was hospitalized a month ago for pneumonia and potential heart
disease. She is on Meloxicam PO BID for arthritis.

PHYSICAL EXAMINATION:
- T = 101.7 F, P = 300 bpm, R = 100 rpm
- Attitude: Distressed, alert, responsive
- Hydration: <5% dehydrated
- BCS: 5/9
- EENT: normal incisors and cheek teeth, MM pink, moist; eyes clear OU; ears clear AU; no nasal d/c
- H/L: harsh lung sounds, increased RR/RE
- GI: abdomen soft and uncomfortable on palp; no organomegaly or masses palp; decreased gut sounds
- MS: ambulatory x4 with no lameness; normal musculature
- Neuro: appears neurologically normal
- LNs: NSF
- Gen/Uro: NSF
- Integ: clean/healthy hair coat; no ectoparasites seen

INITIAL ASSESSMENT:
Discussed PE findings and that Mavis is still in respiratory distress. Rec. radiographs to better assess.

DIAGNOSTICS:

Radiology
Lateral and VD full body radiographs revealed: cardiac silhouette is obscured by severe pulmonary
pattern, dorsal elevation of the trachea is appreciated; pulmonary vasculature is not visualized; severe,
diffuse edema in all lung lobes; diaphragm appears intact; liver is of normal size and shape; the kidneys
are obscured; the stomach is of normal size and axis and contains gas/ingesta; the entire GI tract is full
of ingesta and gas, the cecum is distended with gas; the urinary bladder is small with no evidence of
cystoliths.

TREATMENT RECOMMENDATIONS:
Discussed rads with the owner. Potential infection vs heart disease vs neoplasia vs other. Rec. oxygen,
nebulization, antibiotics, Lasix, and supportive care 24 hrs. owner declined hospitalization and elected
outpatient therapy.

TREATMENT NOTES:
11/3/20
12:30pm Telecom: called furosemide prescription into compounding pharmacy. Furosemide (4 mg/ml) 0.5 ml PO Q12 until directed otherwise (#30 ml; 5 refills).
1:05pm Administered Furosemide (Lasix™) 2mg IM. JMC

TENTATIVE DIAGNOSIS:
­Rule out Congestive Heart Failure vs. Pneumonia
­GI Stasis

CLIENT INSTRUCTIONS:
The following instructions have been reviewed and sent home with your client upon discharge.

Diagnosis:
­Rule out Congestive Heart Failure vs. Pneumonia
­GI Stasis
Your pet has been diagnosed with congestive heart failure and likely underlying cardiac (heart) disease. Left sided heart
failure can lead to pulmonary edema (fluid in the lungs) that can lead to difficulty breathing and a history of coughing and
decreased appetite. The pet may need oxygen therapy, evaluation by a cardiologist, medications to improve pulmonary
edema and cardiac medications to improve cardiac output. Prognosis is dependent on response to therapy and the underlying
cardiac disease that is determined by echocardiogram with a cardiologist. It is very important to follow up with your regular
veterinarian and cardiologist when recommended.

<Removed section about GI Stasis, they diagnosed her with this both times but she had no issues eating, drinking, maintaining weight, producing normal stools>

The antibiotic they prescribed is Sulfamethoxazole/Trimethoprim 40 mg/ml x2/day at .5ml.

User avatar
Tofu

Post   » Sat Nov 07, 2020 9:33 am


Finally spoke with my usual vet. We talked about what could possibly be causing these attacks: could be some kind of generalized seizures caused by a brain tumor or blood clots. She didn't think there was really a way forward medication-wise at this stage. Regarding a possible heart issue, I think the lasix has helped her breathing this past week so we're going to try to double the dose she's getting to see if that might help. It sounds like there might not be much more to do for her besides keep her as comfortable as I can.

User avatar
Lynx
Celebrate!!!

Post   » Sat Nov 07, 2020 11:37 am


Reasonable considerations. Hoping you have more time with her and these issues can somehow resolve.

User avatar
Tofu

Post   » Mon Nov 09, 2020 12:59 pm


My vet did a bit of digging this weekend and is recommending we try Mavis out on Plavix, which has been used in cats and dogs to help prevent he formation of blood clots. She found a few studies of it being used in pigs too, though I am guessing it's rare. Not sure if it will help at this point but it is unlikely to hurt.

Today Mavis seems to be doing fine, she's on the increased lasix which seems to be causing some very soft and smelly poo, and her weight is down a little bit, but is otherwise in good spirits.

User avatar
Lynx
Celebrate!!!

Post   » Mon Nov 09, 2020 10:32 pm


I hope the Plavix helps. She has an unusual condition.

User avatar
Tofu

Post   » Fri Jan 15, 2021 2:53 pm


An update on Mavis: since early November she has been on Benazepril 1mg every 12 hours, and Furosemide 2mg every 12 hours and has been doing pretty great up until the last couple of days. Since her last trip to the ER she's gained almost 100g and has not had any difficulty breathing, nor has she had any additional "seizures", if that's even what they were (a stroke seems more likely to me). Two weeks ago I decreased her furosemide dosage to 1mg/2x a day with the hopes that I could get her down to just once a day or take her off it entirely if her breathing remained stable, but two days ago she has started to make a cough/choking noise once or twice a day. It sounds just like this:
I realized that this is the same thing I was hearing a couple months back, before her first stroke incident.

I am concerned but am not really sure what to do. My vet doesn't seem to have any experience with heart pigs. She was open to prescribing meds after I sent her heart pig info from GL, but it doesn't sound like there are any additional avenues for diagnostics with her besides treating symptoms and hoping for the best. I've already increased the furosemide back to 2mg/2x day but am still hearing her cough. I've got a stethoscope and to my extremely untrained ear her breath sounds are clear on both sides (used a healthy pig as a control), heartbeat is strong. She acts completely fine besides the coughing.


As an aside, I am noticing an increase in mounting behavior and dominance displays from my other pigs towards Mavis over the last couple of days. They could just be in heat and I am reading into it too much, but back in October before Mavis was on any medications, there was a period of a couple weeks where it seemed like they were all ganging up on her and it was just constant mounting behavior. This stopped after she went on meds and I attributed it to the herd knowing she was sick. I am concerned that this behavior occurring again means Mavis is sicker than I know. Has anyone else observed this with a group of pigs where one is sick, or am I just overanalyzing things?

bpatters
And got the T-shirt

Post   » Fri Jan 15, 2021 6:44 pm


That actually sounds like hiccups to me. I don't know whether guinea pigs can even have hiccups, but maybe someone else will weigh in on that.

User avatar
Lynx
Celebrate!!!

Post   » Fri Jan 15, 2021 7:34 pm


I am not an expert on coughs or hiccups but am guessing/hoping it may go away. I know you will be closely monitoring her weight and behavior. I hope they are not "ganging up" on her. Weight loss or injuries could mean you have to rearrange accomodations.

Hoping for the best for Mavis!!

User avatar
ItsaZoo
Supporter in 2020

Post   » Sun Jan 17, 2021 12:11 am


It's possible there is fluid returning in or around her lungs. The fluid returns slowly, so if you reduce the furosemide, you may not see a difference for a week or two before the cough comes back or gets worse. Also, fluid retention is not only in the lungs but could be around the lungs. In that case, you won't hear it if you listen to her breathing with a stethoscope. Either way, the fluid increases pressure on the heart and causes the cough. Furosemide also has mild bronchial dilator benefits that help open the lungs to aid breathing.

If it were me, I would continue with the original recommended dosage of furosemide for a couple of weeks. The medication starts working immediately, like within an hour, to eliminate excess fluid. Within one week you should see a difference with the cough. Furosemide usually needs to be administered at least every 12 hours and sometimes every 8 hours. It just doesn't last long enough to administer once a day.

User avatar
Tofu

Post   » Sun Jan 17, 2021 10:41 am


Thanks, that's helpful information and I didn't realize there was also a longer term effect of furosemide. The timeline seems about right too (I decreased the dose about 1.5 weeks before the cough returned). Based on accounts of other heart pigs I was hopeful I could reduce the furosemide but perhaps Mavis will just need to be on this for the rest of her life.

User avatar
ItsaZoo
Supporter in 2020

Post   » Tue Jan 19, 2021 12:18 am


I know how you feel. Our dog is on furosemide, and I was hoping we could get him stabilized and gradually reduce the amount, but that isn't going to be possible. At least it's not an expensive medication, and it's been around for a long time so it's pretty safe. Just a pain to administer.

I hope Mavis starts feeling better.

User avatar
Tofu

Post   » Fri May 07, 2021 9:47 am


Just wanted to bump this thread to say Mavis, who turned 7 in March (!!), is still trucking along. For a while I was giving her 5mg of Furosemide 2x/day because I kept increasing her dosage when I'd hear her start to cough. After some good advice from Pinta, I increased her dosage of Benazepril up from 1mg 2x/day to 1.25mg and this improved her breathing and the cough completely went away! I was able to decrease her Furosemide dose down to 4mg, then waited a few weeks, then down to 3mg.

After a few weeks of that and no change in symptoms I recently decreased the dose to 2.5mg, but within the last couple of days I've noticed Mavis' breathing has become quite labored. Her weight is good and she acts alert, but is breathing quite hard even though her lungs sound clear. I've bumped her Furosemide back up to 4mg for now and hope to see a positive change in a couple days.

I've got an appointment in for a consult with a different vet and will be asking them about Vetmedin. It's been a minute now since I've had to actually see a vet and I'd hoped it would be easier to get an appointment now that we're more than a year into the pandemic, but nope, had to call three places and the soonest I could get was 2 weeks out. :(


When I started this thread I didn't think Mavis had much longer to live, let alone still be here to eat grass again in the spring, but here's the whole herd enjoying themselves just the other day:

Image

User avatar
Lynx
Celebrate!!!

Post   » Fri May 07, 2021 10:20 pm


Thanks for the update! I am so happy to hear she is doing pretty well. I like how you have been able to fine tune her medications. You sound like a very observant person!

User avatar
ItsaZoo
Supporter in 2020

Post   » Sat May 08, 2021 2:30 am


I hope you have a good vet visit and get the meds adjusted. So nice to know Mavis is out there enjoying that fresh spring grass.

Lisa12

Post   » Sat May 08, 2021 3:22 pm


I am happy for Mavis,too!
What a cool gang of pigs...and they re lucky, here is still too cold for pigs to be outside..:)

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