Infection revisited: second opinion?

[NeoLeo87]

Hi all,

I'm looking for a second opinion about a guinea pig that may have a returned or new infection of some kind.

Her name is Lulu. Female. 2.5 years old. 730grams. Her diet is 1 cup veggies (usually a combo of romaine & green leaf, or romaine & red leaf, with red & green bell peppers. Occasional other veggies (tomato, green bean, carrot, beet, cucumber, etc)), and a cup of oxbow pellets, and 1 vitamin C tablet.

Quick medical facts: On Christmas of 2014, Lulu suffered URI, and was rushed to an emergency visit at a local vet. She stayed there for a week, and eventually recovered. Her symptoms were: imbalance, head tilt, lethargy, less eating, nasal discharge, crusty eyes (one closed completely). Doctors predicted she would always have a weak immune system as a result.

Diet: She has not eaten hay in over a year - or if she does, it's very little. She has been taken to the vet numerous times for this. X-ray shows her teeth were fine, but fluid in her inner ears might be "leftover" from the infection she had in 2014. Doctor assumed this was the reason for her lack of interest in tough food like hay, where the fluid might cause discomfort when chewing.

Fast forward to 06/24/17: Lulu has been given .24cc's of metacam every morning, as recommended to help with discomfort. On thursday, she was running around like usual. On Friday (yesterday), she was lethargic. Today, she shows the following symptoms: imbalance in mobility (falling over), slight head tilt, lethargy, and trouble chewing pellets (she lets them sit in her mouth and gums them). She ate veggies fine, but barely touched her pellets (she gums them and doesn't eat much), and sometimes makes a little soft "mm" sound, a very soft faint noise (hard to describe)> This all happened in a period of 48 hours.

Lulu was rushed to an emergency visit at the vet. The doctor listened to her heart and lungs, checked her teeth - all seemed normal. After that, they suspect the fluid she has in her ears could have come back up (or something else she picked up, they don't know), and said she does not seem serious enough to keep at the vet. We were sent home with medication, and have a checkup in 9 days.

Lulu's medication: .24cc's metacam once a day (for pain relief); .25cc's of ciprofloxacin every 12 hours (antibiotic); 6cc's of critical care (dietary supplement).

Attached are photos of Lulu's current state. I am no expert, but I can't shake the feeling she needs more/better medical attention. Should I be seeking another vet? What signs should I be looking for?

Thanks for your feedback.

[Lynx]

A cup of pellets a day is a whole lot of pellets. Look over weigh.html and note the guidelines for determining if a guinea pig is overweight.
Depending on the content of the pellets, your guinea pig may be getting too much calcium.

The above may have nothing to do with the current issue.

Do read over antibiotic_advice.html in case she has problems with that antibiotic.

I wish I had some ideas for you, other than the possibility of another URI (it seems that is what the vet is treating). Hopefully Talishan will check in (more experienced than I am).

[daveandtiff]

Had you seen an exotics specialist? Was doctor able to see as far back as the molars to be sure no new changes, that they were not overgrown or no injuries within the mouth? The previous xray did not show root elongation am guessing? Has the metacam seemed to help with discomfort at all? Has her weight changed?

Seeing her hunched position, unless this is how she sleeps, does seem concerning (having had a boy who came with dysplasia/arthritis, eye condition, and nasal discharge who did similar). There was no bloat?

I think I would err on side of caution and find a reputable cavy doctor for another evaluation. Would she take her pellets if they were wettened (refreshing often to prevent mold if she chooses them this way)? If she is not eating hay, the pellets may be primary way of her getting some hay-based fibre into her, and supplementing with critical care might be a thought if she is not keeping her weight, to help keep intestinal tract balanced, and for added nutrition. Quantity-wise, is she eating as much vegetation as usual, and navigating it well with her teeth? Does she drink a decent amount of water?

[NeoLeo87]

Answers and updates

Lulu is doing slightly better tonight. She's a little more stable, no head tilt, both eyes are open. She still shows slow movements, puffed-up stances, and slow at eating - but she is eating (pellets, that is). She was given another dose of ciprofloxacin (she gets this every 8-12 hours), which she took with skepticism, unsure if she likes it or not... Tried giving her critical care, showed no interest (She has taken critical care in the past, and loved it. Not sure why she doesn't now).

Thanks for the links, Lynx! I'll look into pellet intake, but Lulu has never been overweight, just on the cusp of underweight. Haven't found a solution to get her eating more hay.

Dave&Tiff, the vet works at "Avian & Exotic Animal Hospital" where I'm from (I live in New Orleans LA). Doctor used one of those pocket scopes (the kind doctors use to check inside human ears) with a light, to check inside her mouth. She didn't see anything, and according to x-rays (done a few months ago) the teeth looked fine. Root elongation? Not sure, I'll have to call Monday and ask.

As for metacam results; unsure. Her diet hasn't changed recently, and her weight mildly fluxuates (no big changes). Doctor who saw her for eating suggested the metacam once a day for...forever? I have given a dosage every day the last month. If this has not been showing any changes/results, should I consider taking her off the metacam?

Diet is as usual. 1 cup of veggies each morning. She ate them all fine today, and was eager to. Navigating with teeth? Uh...she turns her head from side to side while trying to eat lettuce, and eats slower than Popcorn (the male pig (they live separately at the moment)). She drinks from her drip bottle, but not a lot, and she always drinks with the side of her jaw (never puts her whole mouth around the end).

No bloating was found. Though I don't know much about dysplasia/arthritis, I will keep that in mind when finding a 2nd clinic on Monday. And I'll keep an eye on her throughout tomorrow.

[daveandtiff]

That is really good that she looks improved and has started in on her pellets, and that she is eating as much vegetation (hopefully the vegetation provides fluid enough that along with her water intake produces nicely shaped and sized, not dry-looking poops).

Was the head xray from a few months ago taken while she was under anesthesia? That may be obvious protocol for your doctor, but thought to ask. If so, root elongation should have been able to be spotted. If neg, would be wonderful. Still, a few months passed can reveal new conditions, especially where it doesnt seem she is eating hay that would grind down those molars. Do you think she would accept and be able to handle very narrow 1 inch pieces of inner corn husk, or washed outdoor grass (the type with the rougher surface)?

Lulu is pretty young, and unless she has challenges with her organs would not think this dose of metacam would be harmful, particularly in the short-term. Some who experience chronic pain are kept on low dose metacam. We were given long-term metacam, 0.10ml twice/day, for our boy with dysplasia (who was close to your girl's weight, and incidentally also had malocclusion/trouble navigating pellets and other foods, had forgotten to mention). Often, a doctor will offer metacam when there is not clear indication of what the source of trouble is, with the hope that if condition is pain-related the medicine will get piggie to eat or move normally again. But if you don't see improvement while on it for awhile, would talk with doctor and determine best next step.

The side of jaw drinking may be normal, or could show a sensitivity to the opposite side. Is there eye/nasal discharge to the opposite side or any favouring of that side while eating? Alot of pigs will aim for the bottle using side of mouth, sometimes rounding mouth over nozzle after meeting the tip from the side. Are the food pieces going equally side-to-side when she chews? By navigating food, am referring to being able to pick up, bite off and tear off pieces, not have pieces drop out of mouth, not coughing or pawing food out of mouth, not appear to be having difficulty getting something down the chute... Comparing her eating style to your other as you have is a good idea. Will help to make note of any differences to doctor.

For our boy, dysplasia was suspected as he sat in one place more, bunny-hopped or was hunched with discomfort. I believe the doctor pressed joints and recognized his reaction as well. The diagnosis was confirmed on xray, with joint swelling and slight deformation of many of his ribs, and his mobility and range of motion was helped with metacam. If your little girl is walking normally and getting around (or has not had Vit C deficiency/scurvy at any point in her life previously, as our boy had), this might not be a concern for her. Her hunched position just grabbed my attention when I saw it in your pictures.

Critical Care can become boring (as I've seen with ours). There are a couple of flavours to try, or you can juice vegetation or grind hay treats into food to make more enticing. Good news her weight is generally maintaining. If you were to offer CC at this point, would probably be more for added nutrition and fluids. Try the syringe from both sides of mouth to see if she can take it without trouble. Another of my boys had experienced an incisor fracture at the hand of former doctor who was trimming his teeth. He would not eat from the injured side while painful.

I'm pretty curious about the fluid in her ears. It was seen on xray in 2014? But was it *seen* again recently or just suspected? The head tilt might point to ear, but was wondering how much of this thought was hunch and how much evidenced.

[Talishan]

I'd want a full mouth exam under very light sedation. Their buccal pads fill their mouths, and even a good, experienced cavy vet can miss points on the teeth and mild malocclusion with an otoscope.

Ditto on the corn husk suggestion. Feed the clean (inner) husk after rinsing it off. Tear into long strips. They usually love it and eat it like slurping spaghetti. It has a *lot* of silica in it, and wears the teeth well.

Try breaking the metacam into two doses roughly twelve hours apart. What is its concentration (likely either 0.5 mg/mL or 1.5 mg/mL)? You may be able to increase her dose a bit. In any case, most of the time I've had better success with Metacam dosed 2x daily rather than once. We've had pigs on it for months or even years with no apparent ill effects. We have had a couple to have weird reactions to it, and for them we used carprofen (Rimadyl).

Be sure to give probiotics an hour to an hour and a half or so after each antibiotic administration. A little more throughout the day won't hurt and will generally help. Baytril can be dosed once a day; if it becomes problematic, double the dose and give it once a day rather than twice.

She's a beautiful girl. My best to her and to you. Please let us know how she's doing.

[Talishan]

This may (or may not) be helpful:

https://www.guinealynx.info/records/view ... f=52&t=250

I'm ambivalent about whether to suggest a second opinion or not. The vet you're seeing seems to be doing the right things.

[Lynx]

according to x-rays (done a few months ago) the teeth looked fine

Teeth can change dramatically in a very short time (even two or three weeks). So more thorough dental exam would be a good idea.

Did you say something about favoring one side eating? Is the jaw somewhat at an angle?

You mentioned a cup of pellets per day. You mean your guinea pig eats 8 ounces of pellets every day?

[Talishan]

Lynx, she doesn't eat any hay.

I cannot speak for OP of course, but perhaps she dumps out any uneaten and refills the bowl daily. If I lived in Nola I would. Georgia's humidity is bad enough and Nola's worse. Just guessing though.

[NeoLeo87]

Answers and updates 6/26/17 - Lulu is having ups and downs

The upside: No more imbalance or head tilt. Eyes and nose are fine (no discharge (there wasn't any to begin with)). When awake or active her behavior and stance are normal. Shows interest in what she normally eats. Still enjoys metacam, lost interest in the cipro (I'm manually giving her cipro by wrapping her in a "burrito," she doesn't fuss too much with eating it).

The downside: When rested, she has a puffed-up stance, and gives little occasional ear twitches, and a subtle "jerk" forward or to her side. Like something startled her or she's uncomfy. She took 30 minutes to eat a cup of veggies (took the male pig 5 minutes). Might be due to some critical care I oozed from a syringe onto the veggies (in hopes she would eat it), but Lulu showed no interest until the veggies were washed. Struggled to nibble her vitamin C tablet, and didn't touch any of her pellets. Poop is smaller than usual, sometimes dry.

Dave&Tiff, The x-ray was full body, and taken in January. She was under anesthetics. Haven't tried corn husk, but if I can find some at a store today I'll try it. Sorry to hear about the boy with dysplasia, but thanks for the advice. I will definitely ask about dysplasia, or any swelling of joints or ribs, and a re-check of her back molars and root elongation.

How she eats: the male pig holds his head straight and chews food, eating up whatever he picks up. Lulu turns her head from side to side while she eats, drops pieces and picks them back up. Sludge or water drips down her chin (sometimes a lot, sometimes not). You said you "grind" hay down? Should I blend the hay with water or some supplement, see if she eats hay that way?

And yes, the fluid in her ears was seen, not suspected, on x-ray. They assume the build-up is left over from URI two years ago, and the infection may have come back. They also think the pressure of said fluid in her ears affects her back jaws (thus the whole chewing problem). The URI from 2 years ago - along with nasal and eye discharge, head tilt, sickness - was a one-time incident. This thread is in regards to "some" of those symptoms (no discharge) that caused my taking her to the vet on Saturday, just to be clear on what she currently is going through.

Talishan, I'll press them on using a buccal pad with light sedation, instead of just the otoscope. I want to be triple sure she's not having malocclusion, despite what they've said. What happens if metacam and cipro are given within a half hour of each other? Vet never mentioned anything about giving the dosages 1-1.5 hours apart. Her metacam concentration is 1.5 mg/ml, too. And thank you for posting those links! I'll check them out today or tomorrow. And yes, I refill pellets daily. Humidity is very bad in NOLA.

Lynx, agreed, I'll make sure we do light sedation and x-rays to get another full examination of the teeth. I'm not yet convinced the teeth aren't the issue. The jaw is not at an angle, though. And no, not 8 ounces a day, but probably 4 ounces. She hasn't eaten hay in a long time, and only focuses on pellets and veggies.

When I got Lulu in December of 2015, she was very vocal with loud wheeks and ate plenty of hay and pellets, but over gradual period of time she stopped hay altogether (and yes, she was still eating hay and vocal after recovering from URI). Could be spending time with the male pig, could be her teeth, could be something else. Doctors could not figure out why. She doesn't even register hay as food. I'm not sure if 4-6 ounces of pellets a day, for the last year, has any big impact on her current state, but I'll bring it up with the doctors. They did not seem concerned about her eating that many pellets.

Here's pics of Lulu and her poop from this morning, along with her papa (that's me) giving her lettuce as a treat after cipro.

[daveandtiff]

She is a very sweet girl! How is her weight? Is she having better appetite?

Do you notice hair below her mouth is wet, on one or both sides, even when she is not eating? This can happen with malocclusion, though a pig can have malocclusion without this. The ear twitching might point to malocclusion as well, as we had seen this with a couple of ours who had malocclusion. Ours also had more tendency to bite themselves while eating causing them to jump or jerk forward. It would be a good idea to have her lightly sedated for a better look at molars and the general area inside mouth (gas anesthesia is safer, more quickly reversible). Inflammation or pressure caused by her ear condition could lead to discomfort when eating certain things and in turn cause her to not be able to eat hay or certain foods, which could lead to malocclusion if she is not self-maintaining teeth.

There could be issue with surrounding bone or tooth root as well, but would hope xray might have shown this. Someone here might be able to say if they feel the full body xray is as precise as needed compared to the head xray, but that she was not moving during the xray should have given clearer images.

Regarding your medication question for Talishan...what I think she was saying was that a probiotic (something like Benebac or Probiocin) is helpful when giving it 1-1.5hrs after a dose of antibiotic. This is to help replenish normal gut flora that is disrupted by an antibiotic (similar to if you or I were to eat yogurt during an antibiotic regimen). It's better to wait a little while after giving the antibiotic to offer the probiotic. It could help keep stools looking more normal and prevent some abdominal discomfort. Some doctors recommend probiotic use, some do not think to mention, but it is discussed alot here on guinealynx. As far as I'm aware, it should be fine to give Cipro and Metacam at the same time. Then the probiotic 1-1.5hrs after.

The poops do look a little dry, but aren't exceptionally small. But you know what her normal is. Is she drinking from her bottle?

You could try grinding hay in a clean (or new, designated for piggies only) coffee grinder. We use one daily. Strands of hay are difficult to grind, but compressed hay cubes work well in the grinder. What we then did was sift out the strands that would not easily work through syringe barrel and mix the finer stuff into critical care. It doesn't congeal with water alone, need something pasty to go along with it. Some folks here cut the tip of a syringe off and file down end with a nail file to smooth sharper plastic edges, allowing for thicker food to be able to be pushed through syringe. Experiment and see what you can come up with. She might grind the hay within the mix, but even if it did not greatly impact tooth surfaces, it would help intestinal tract. I would also break tiny pieces of oxbow hay treats and offer these to the mouth, which piggy would willingly take, but would sometimes struggle to work on. Once the malocclusion has progressed or if after many filings a pig's teeth no longer allow him/her opportunity to eat on own, chewing anything (including vegetation) becomes difficult. Have you tried different types of hays? Could fresher hays or some that are more fragrant or sweet smelling be more interesting to her?

[NeoLeo87]

Update 6/26/17 cont'd - Lulu is not eating

My last update was from this morning. As the day progressed, Lulu barely touched any more food. She is not eating her pellets, and as far as I know, not drinking from her water bottle. When rested, she sits in a hunched, puffy position.

Sometimes her feces is rice-sized and dry. Other times it's larger and moist (but not runny). She pooped about 1/3 the usual daily amount of feces. Her weight is stable at 730-735g.

My girlfriend and I had to force feed her the cipro again. We tried critical care, no luck. In a last effort to hydrate her, we forced some water by syringe as well. She took it fine. She also ate some collared green afterward.

Dave&Tiff, I have tried: western timothy hay, oat hay, orchard grass hay, botanical hay, and a few others. At least 6 kinds of hay. She won't eat any. She has not eaten hay in maybe a year. I could try the hay/critical care mixture, but it will have to be a flavor she likes (apparently she won't eat apple and banana), and I will have to find a coffee grinder, hopefully tomorrow, to attempt it.

I have not considered probiotics, but I can look into it at some point. Thanks for the advice on the body gestures as well.

I'm not sure what else to do at this point, other than wait and watch. Her appointment with the vet is 7 days away.