Antoine (M)--Pulmonic Stenosis (Heart Disease)

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Post   » Sat May 03, 2008 6:06 pm

Name: Antoine

Sex: Male, intact

Breed and Variety (Color): Teddy, Dark-Eyed White (w/red shaded splotch on back)

Age at Acquisition (May 2000): at least 6 months, unable to document fully, but full grown adult.

Rescue from a chain Pet Store (not purchased) after being discovered in a back "holding" room for ill animals.

Signs of Illness: When acquired had poor body condition (thin and poorly muscled), hair loss with scurf, urine scald, signs of poor husbandry in general.

After acquisition: Guinea pig lost weight even when eating and drinking, urinating, and defecating normal amounts for the size and age of the guinea pig. Unkempt and scurfy coat continued. Ear margins seemed to grow black (necrosed) and tissue fell off, giving the ears a ruffled look. Breathing seemed more labored than in a normal guinea pig with usual activity level.

Initial Treatment: Course of ivermectin for hair loss/possible mites. Appropriate diet and care. Some improvement noted in the coat condition, but since weight loss, ear margin necrosis, and breathing signs persisted, further treatment pursued.

Follow-up Diagnostics and Treatment (August 2000):
Complete Physical Exam: revealed a very loud heart murmur that was able to be asculted with a pediatric stethoscope, palpated through the chest, and visualized with jugular pulses present.
Fecal test: negative
Blood panel: CBC showed stress leukogram, liver indices ALT 90 (normal 27-29) and AST 246 (normal 40-45) are elevated
X-rays: Heart enlarged, mishapen, round in appearance, no excess fluid in the lungs or abdomen
Phone Consult: UC Davis (Local Veterinary Teaching Hospital)

Recommended Treatment: Suspect GI Disease. Banamine (flunixin meglumine), a powerful GI NSAID at .01 mg/pound SID for 3 days. I also supported with vitamin C at 50-100 mg SID, SQ fluids at 30 mls SID-BID with B vitamins added. He was getting at least 15-30 mls of Oxbow Critical Care supplemented daily.

Results: His appetite and attitude improves briefly on the Banamine, but then recedes again.

Further Diagnostics and Treatment (October 2000):
Consult at UC Davis
Physical Exam: His murmur is rated as a grade 4/6 systolic left basilar murmur. Jugular pulses present.
Bloodwork: Continued stress leukogram and WBC elevated to 35,000. ALT and AST consistent with earlier bloodwork. He was anesthetized for a jugular blood draw.
X-rays: Consistent with previous x-rays
Ultrasound of Heart (ECHO): Diagnoses his murmur as pulmonic stenosis, a malfunction of the pulmonic valve in the heart. It is a congenital (present from birth) heart murmur. Usually the treatment is surgical in other animals and no medical treatment is available. No one known does heart surgery in guinea pigs that UCD could refer us to. His poor, emaciated state makes him a poor surgical candidate.
Ultrasound of Abdomen (brief): His hepatic veins are distended, which is consistent in severe heart issues. He has no pulmonary edema nor ascites (fluid in the lungs or abdomen) which are further signs of congestive heart failure.

Results: Poor prognosis. There is no treatment recommended for the heart problem. Since the liver is enlarged, it is suspected to be the main problem. Mass (neoplasia or cancer) in the liver or abdomen is suspected. The resident clinician recommends doing an abdominal ultrasound of the entire abdomen, a liver biopsy, a bone marrow biopsy (since there may be a higher number of young RBCs in the circulating bloodstream), AND an abdominal exploratory surgery. I decline due to the poor prognosis and the low potential of such a debilitated pig to survive such procedures. The clinician suspects Antoine will die soon, even if any treatment is pursued.

I continue aggressive supportive care (hand-feeding Critical Care and SQ fluid therapy)
Antoine gains 30 grams of weight. I investigate other options.

Further Consultation (October 2000):
Consult with Dr. Nye at Midwest Bird and Exotic Animal Hospital in IL: Reccomends adding medications to manage heart disease and further support Antoine since he is obviously dying.

Treatment: Enalapril 1/8 mg SID, prednisone 1/4 mg SID, silymarin (milk thistle) extract SID

Results: Improved demeanor, more energy, weight gain
Recheck bloodwork (November 2000): WBC decreases to normal values, liver enzymes (ALT and AST) are still high, if not a bit worse (102 and 273 respectively).

January 2001: Antoine continues to improve. He’s gained 80 more grams since November (weighs 850 grams). He’s been weaned off of the prednisone and the enalapril is decreased to 1/8 mg EOD. Discontinue SQ fluids, but continue supplementing with Critical Care in a bowl (which he devours).

March 2001: Doing very well on enalapril and still gaining weight. Up 100 grams in past 2 months (weighs 950 grams).

February 2002: We’ve made it more than a year on maintenance enalapril. I’ve discontinued the Critical Care months ago. Except for the heart meds, he gets no other special reatment diet or management wise. He now weighs 1260 grams. His labwork shows his liver values are nearly normal. His ALT is 37 (normal range 27-29) and his AST is 55 (normal range 40-45). He’s one bright and happy little pig and now lives with two sedate Silkie boars. He loves to rumblestrut and chase them around. We try to taper off enalapril over the next few months, but he starts to get graying ear margins and slows down a bit. We keep him at 1/8 mg EOD for many years. I discontinue the milk thistle extract.

July 2003: Weight is now 1020 grams. He seems bright and fairly well. Labwork is consistent with last year (mild ALT/AST elevations, non-clinical). Due to the weight loss over the past few months, we do a full body ultrasound (with a radiologist) and jaw x-rays. All are within normal limits, except for the heart issues and a possible blocked ureter. A urinalysis is run and within normal limits. His x-rays are non-remarkable. Dr. Legendre consults via email saying his teeth below the jawline look healthy. Since nothing can be done surgically for the possibly blocked ureter, we maintain current treatment.

November 2003: Antoine’s two cage mates have died, so I try pairing him with other boars. One match doesn’t work out and he ends up with a bite wound abscess that takes 3 months to heal with two antibiotics (Baytril and TMS) and two separate surgeries (local anesthesia only).

August 2004: Antoine is successfully paired with a younger Silkie boar named Ciel. They are very cute together. Ciel is a 4 year old orphaned and hand-raised baby that screams a lot, but he eventually starts to bond to Antoine and they groom each other.

September 2004: Weight 980 grams. Labwork is starting to show a bit of liver elevations again. ALT 43, AST 81.

March 21, 2005: I’m suspicious Antoine is having some problems since he looks a bit different. I increase his enalapril to 1/8 mg SID. His skin is starting to be scurfy, so I start ketoconazole shampoos.

March 31, 2005: Antoine is very edematous and lethargic. I take him to see Dr. McKenzie. X-rays show very little heart detail, but the changes are consistent with heart enlargement, pulmonary edema, and ascites. He’s in congestive heart failure. More bloodwork is taken (fairly normal, ALT is now subnormal at 23, and AST is 66). I decide to give it all we can and start diruetic therapy. We start Lasix at 1 mg q6h and enalapril at 1/8 mg BID. He weighs 1000g at the vet’s.

April 1-4, 2005: I increase his Lasix since his labwork looks normal (we were concerned about kidneys). His enalapril eventually gets increased to 2.5 mg BID. He's getting anywhere from 3-4 mg Lasix every 6-8 hours with not much effect. His edema is starting to subside on the 3rd, but by that point I know we're in a losing battle. I'm weighing him every 6 hours and taking heart and respiration rates, which remain fairly static. He continues to eat his veggies and I try not to limit his veggies much even though I'm concerned about monitoring fluid intake and output.

April 4, 2005 (Evening): He's very weak, but sweet to the end. I give him some veggies as he tries to stand. I know I have to end his suffering. He purrs as I give him the injection and he quickly loses consciousness.

RIP Antoine 1999?-4/4/05
Treated and maintained on heart meds from 10/00-4/05 (4 1/2 years)

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