Moon's Medical Topic

[Lynx]

Hoping it resolves and there are no other issues!

[AviN4]

I've fallen behind on posting an update on this. I tried the gentile soaking and massaging approach approximately once per day for a week, and I didn't see any obvious improvement in the amount of tearing in his eye or gunk on his fur. I took Moon to Dr. B, who said it could be some kind of eye infection. He said a blocked tear duct was possible, but he thinks less likely since that tends to happen at a younger age. He gave me a course of gentomicin antibiotic eye drops. He also suggested that instead of massaging the eye, I should just apply the clean, warm, wet cloth over the eye for about a minute at a time. Within 1-2 weeks, Moon's tearing had resolved.

[Lynx]

That is excellent news! Thanks for the update.

[AviN4]

This is a follow-up to my thread Boar introduction: initial success followed by conflict, which now more clearly belongs here. Moon had seemed to be doing OK since my last post on Jan 14, but took a significant downturn early morning Jan 21 (yesterday). He had apparently spent all day in his hideout, with very little eating or drinking. Later in the day, I found that his weight had dropped to 974 grams, an alarming 70 gram decline from just 2 days beforehand. I already had a vet appointment scheduled, but expedited it (albeit with a less preferred exotics clinician) and brought him the same day. During the exam, Dr. D observed the following:

• Dr. D found a wound on the inside of Moon's ear flap that I was not previously aware of. I had checked Moon for injuries during and after his tense time with Paulie, but somehow I missed this. Dr. D believes there could be an infection here.
• Dr. D found evidence of discharge from Moon's eye. I explained that this was a chronic issue, that multiple rounds of gentomicin antibiotic eye drops did not seem to help long term, but that with weekly cleanings, we went a year without it causing obvious discomfort or other medical issues. (Note: I mistakenly wrote here in April 2023 that this was resolved by the antibiotics, and also mistakenly failed to provide an update after that. I apologize for that.)
• Dr. D observed unusually heavy breathing, and thought Moon could have a lung problem. They did 2 full body x-rays of Moon, but did not observe any fluid in his lungs or any other evidence of lung problems. The only problem observed on the x-ray was significant arthritis.
• Dr. D reviewed Moon's teeth and found that they looked fine, other than wear on his molars. No overgrown teeth.
• Dr. D collected a blood sample for further testing.

Based on the above observations, Dr. D prescribed the following:

• tribrissen liquid 1 mL, oral, 2x per day for 7 days. The liquid is pink. I believe this is the same as bactrim, probably 48 grams per dose.
• animax (nystatin-neomycin sulfate-thiostrepton-triamcinolone) ointment, applied to affected area (on ear), 3x per day for 7 days.
• meloxicam 1 mL at 0.5 mg/mL, 1x per day for 7 days. I believe this would be 0.5 mg per day. (Dr. D may have prescribed this because I asked about painkillers.)

Since taking Moon home yesterday, he has been eating very little food on his own. I've begun syringe feeding him Critical Care mix and water to try to keep his weight up and his digestion moving. I've also observed that he is very lethargic. He stays in hiding without moving around much. He even had difficulty sitting normally, with his feet sliding on the coroplast floor, falling into the gaps between the bedding. (I put a fleece blanket on top to help with this.)

I believe Dr D gave antibiotics mostly for an infection from the wound on his ear. However, reading the symptoms of an upper respiratory infection on GuineaLynx, I wonder if that could be the cause? He meets 4 of the 9 symptoms listed, specifically:

• Refusal to eat or drink (anorexia)
• Labored breathing, wheezing [I didn't notice this, but seems consistent with Dr. D's observation]
• Discharge from eyes or nose (read about normal Eyes) [Though this has been a long-term issue]
• Lethargy, hunched posture

Either way, I think Bactrim is a reasonable first-line treatment, so I'm not sure if it would imply an immediate need to change anything? Though if he doesn't respond to Bactrim within a day or two, should I ask for Baytril?

Thank you all in advance for any advice you may have.

[AviN4]

Below is a photo of the wound on Moon's ear. It previously had a scab over it, but it fell off after a few gentle applications of the animax. The photo is from after I applied the animax ointment, so that's why it looks a bit wet. (It was dry before I applied the ointment.)



I can also provide x-ray photos and a copy of the exam report, if either would be helpful.

[Lynx]

Poor little Moon. Looks like he has problems!

You are so precise and observant. And know how to hand feed, etc.

I try to remember to encourage people to ask their vets when you should see improvement. While Bactrim is well tolerated, you may be correct that another antibiotic would be more effective. It is reasonable to see how he is doing on the Bactrim and if you are not seeing improvement in your suggested day or two, find out from the vet how long it will take to see improvement and go forward from there.
https://www.guinealynx.info/antibiotic_advice.html

I'm glad you brought up pain medication ( can make a difference). The vet sounds reasonably thorough and competent. Surprised nothing seen on the xray that would indicate fluid in the lungs.

[Sef]

Ditto Lynx. I think starting with Bactrim is probably reasonable, but it's generally not considered as effective as Baytril for certain types of infection.

You mentioned no fluid showing up on the xrays. Was the vet able to rule out any enlargement of the heart or any other indication that he could have a heart-related issue?

[AviN4]

Thanks for the helpful replies.

Sef, Dr. D did not mention any heart issues. She said that the x-ray showed arthritis and no other problems. I'll follow-up with x-ray images, if you or others happen to know how to spot this on an x-ray.

As a general update, the wound on Moon's ear seems to be improving, and it's possible he's started nibbling on more hay, but I don't see any improvement other than that. His weight has been mostly stable, but that's with a total of ~90 x 1 mL syringes of Critical Care mix and water daily. Other than nibbling on a small amount of hay, I don't think he's eating or drinking much at all. He's also still very lethargic, with difficulty walking or standing.

Dr. D is not in today, but I talked to Dr. M, another clinician at the same office. Dr. M said that blood test results had returned, and she thought that an abnormal metric related to kidney function to could be an indication of nausea. I did receive the full report, but I don't remember which metric it is and it's not obvious from the report. I've requested an update. Dr. M suggested Metoclopramide for the possible nausea. I'll pick it up later today for use if warranted.

I asked about the possibility of a URI and Dr. M seemed to agree that it was possible. I asked about Baytril and she said she'd be fine trying Baytril, and prescribed Baytril 40 mg / mL, with a dosage of 0.1 mL, 2x per day. But she says it's hard to get it in oral liquid form, and that the best option would be to get it compounded from Chewy. Best case scenario, I get it by tomorrow morning. Though I worry it could take longer.

Dr. M also said I could bring Moon in and they can inject the first dose of the Baytrin. I might do that, though I'm hesitant about the stress to Moon. The third option I came up with is to get 22.7 mg tablets of Baytrin, crush them, mix them with 5 mL water, and dose 1 mL at a time. I believe that would get us to 4.54 mg. I've sent an email to the office to check if they're willing to prescribe that.

[AviN4]

Here are the low resolution x-rays. I can get share higher resolution x-rays later, if those would be helpful. It's more complicated since they are in DICOM format.

[AviN4]

So, the receptionist at the vet office says that Dr. M says that it's the BUN that's high. But I don't see it: it's 16mg/dL, which is within the reference range of 9 to 29.



I checked some other sources for varying reference ranges, and it still looks within those. Example here. So I think Dr. M is likely mistaken. Given that, I wont proceed with the Reglan (Metoclopramide). (Note that Dr. M is not the vet I'd normally visit, but neither Dr. B nor Dr. D are in the office today.)

Dr. M has also declined to prescribe the Baytril tablets to be crushed, because she is concerned that the dosing wont be sufficiently accurate. And she also declined to inject the Baytril, because she says it would be 2x per day and stressful for Moon. She advises that I wait for the order from Chewy. If all goes well it'll arrive tomorrow. I just hope the unnecessary delay doesn't end up killing him.

[Lynx]

Baytril is very caustic and not recommended as an injection (though sometimes given once at a doctor's office to jump start treatment). The injectable form is often given orally. I think bitter, years ago I would draw the dose and then also draw in a tiny bit of jelly to make it more palatable.

[AviN4]

Thanks, good to know. I would have happily taken the injectable as an oral solution temporarily, but I didn't ask at the time, and I doubt Dr. M would have agreed to prescribe that. I'll keep that in mind in the future though. I'm also making a mental note to stockpile Baytril in oral liquid form so I don't have this problem again.