ANTIBIOTIC INTOLERANCE CORRESPONDENCE
DOWN TO THE LAST STRAW
Patches' case history is a cautionary tale of antibiotic intolerance and how some bacteria may be insensitive to some antibiotics. Below is the email correspondence between Guineapapa and I (Pinta) that gives a blow-by-blow account of Patches' near death experiences (more than once) and recovery.
Wed, 22 Sep 1999 You responded to my topic of a sick guinea with presumably a urinary tract infection. My guinea is all but stopped eating. I am down to giving him baby food thru an eye dropper but I can only get in 4 cc.
Any ideas how I can give him more food to keep up his strength. I am hoping with the medication he is currently on ...sulfate... no longer baytril, and time, that he will ride out whatever infection is inside him.
Wed, 22 Sep 1999 A subcue treatment is your best bet. We have, with very sick pigs, taken them in once a day for hydration, drugs and vitamins all in one treatment. We have also done the handfeed route making up a slurry of *pellets, cooked rice, greens, cranberry juice and yogurt. If your pig has kidney or bladder stones, the yogurt is a bad idea (too much calcium).
* Critical Care from Oxbow is an excellent premixed handfeeding formula created expressly for small herbivores.
Thu, 23 Sep 1999 Took your advice and pressed my vet to stay open late and give Patches a subcue of hydro, vitamin C and vitamin B.
He made the night and ate some lettuce this morning. He's not out of the woods yet, but at least I feel he is going in the right direction. There is a test result we are waiting for to tell us if we need to change his antibiotic or not.
Patches came down with this over Labor Day weekend and has been fighting it ever since. He is only 1 1/2 years old so I am more inclined to expense recovery options then to admit old age as a factor.
Thu, 23 Sep 1999 I would definitely recommend a daily subcue combined with hand feeding. If he is eating enough by himself, there's no point stressing him with the handfeeding but I have had a few pigs that actually seemed relieved to be handfed and were very cooperative with the syringe. Just make sure he's swallowing. I push the syringe to their back teeth and wiggle it a bit to make them grind. If it doesn't go far enough, they close their throat and it all dribbles out. Do not continue handfeeding if there is no chewing action. You risk plugging their windpipe then. We also feed the sick pig in a separate basket with highly desirable foods: fennel fronds, fresh picked long grass, dandelions, greens they don't usually get, like beet tops, clover, tomatoes etc.
Thu, 23 Sep 1999 I find force feeding very stressful on both me and Patches. He accepts the
syringe up to a point and then stresses out when I try to give him more.
I have him in with his healthy mate, Miss M. I feel she is a positive influence on him and he seems to take a recent liking to eating her droppings. (Which I found out recently was normal and beneficial).
The size of his bladder is 1/2 the size it was a week ago which leads me to believe that he is getting better than worse.
Thu, 23 Sep 1999 I read in a Peter Gurney column that a sick pig showing interest in and eating another one's beans is a sign of recovery and very positive.
Fri, 24 Sep 1999 That's probably the best news I gotten all week (about eating of the beans).
Last night after Patches ate an unimpressive meal, I brought him outside in the back yard. Well, he quickly became our new little guinea-lawnmower and proceeded to eat a lot of grass. That made me feel better.
This morning I made a better effort giving him food through a dropper. I was able to get 10cc of carrots and bananas baby food into him with very little spit-up. I try to combine this with him snacking on some timothy hay. Hopefully once he is done taking the sulfate antibiotics (next Monday will be 10 days), he and his appetite will return to normal. He has certainly become thin.
Fri, 24 Sep 1999 That's great! I was going to caution you "Beware of the last Hurrah" but if his appetite is on its way back, I'll go out on a limb and say he's out of the woods. The "last hurrah" is behavior we've noted with most pigs that exhibits itself the night before we lose them: They seem to suddenly improve and make a point of visiting all their fave spots in the living room. They become quite animated and seem very enthusiastic. They won't eat much, if at all, but show great interest in food. This period lasts 3 - 4 hours then they slow down again and the next day, they're gone. This last hurrah seems to happen to humans too. It seems invariably, just before someone dies, people always say " he was doing really well, he seemed to have rallied. I thought we'd be able to check him out this afternoon...."
I know some of our pigs have had a reduction of appetite on sulfa but, unfortunately pigs are very limited in what drugs they can take. Have you checked into Vibravet (Doxycycline)? If the sulfa is compromising his appetite, you may want to switch again. Maybe the Vibravet will have an effect against his infection, which, by the way, has it been confirmed as a urinary tract infection?
The important thing is to keep his weight up. Try a slurry of pellets, dandelion, and cranberry juice. At this point, I would weigh him daily, so you can be sure, he's packing on the grams. Grass is great for him right now. As a herbivore he needs to get fibre moving through his system. As long as you feel it's making a difference, I'd keep up the subcue too. You could ask the vet if he can suggest an appetite stimulant. Steroids sometimes work, you just have to be careful you don't end up compromising the immune system.
Sat, 25 Sep 1999 For Patches, he was on Baytril for 10 days with no improvement to the infection (his bladder became more enlarged) so the vet switched him over to sulfa for 10 - 15 days, starting 9/17. Gave him a subcue of hydro, Vitamin B and C on Wednesday also found out his bladder was 1/2 the size since 9/8.
We are on our 8th day and this is his current situation:
More alert, travels around the cage, exercises
High interest during snack and dinner time
Will only eat grass and Timothy Hay
Picks at the lettuce, eating only the fancy, $7 LB kind (figures)
Very interested in Miss M's poops
Occasionally eats food pellets
In the mood for love with Miss M about 3 times a day
Keep the grass and hay coming
Syringe feed him 8 CC baby food carrots, 5 CC bananas, 4 CC yogurt twice
Feed Miss M lots of food so she produces good beans for Patches
Can he eat as much grass as he wants?
I was going to give him another subcue treatment Monday evening. He's not a big water drinker, never has been, but we soak the grass and the fancy lettuce before feeding it to him.
Is there anything I should change in my approach?
Sat, 25 Sep 1999 Give him as much grass as he wants, and hay too. He's probably getting enough moisture form the syringing but if you're concerned, you can syringe him some water or better yet, cranberry juice. Sounds like the sulfa is working. I'd still try to introduce pellets in a slurry (nuke pellets with water or juice and let cool) for syringing to get fibre in his diet. Otherwise, I think you're doing great and it looks very positive.
Another thought: If you can give him organic, unfiltered, unsweetened cranberry juice, so much the better. It's expensive but can be very beneficial. The **yogurt is great to help replace some of the beneficial bacteria wiped out by the sulfa. I would caution you, though, to make sure the bladder infection is not related to an inability to metabolize calcium, in which case, the yogurt would only contribute to the problem. You can get an idea of whether or not he's metabolizing calcium properly from a pee sample. If it's thick, greyish and sludgy, it's a sign more calcium is being peed out than being metabolized by his body.
His appetite probably won't be completely back until he's been off the sulfa for 24 to 48 hours. Til then, keep syringing the food down.
You could also give him some **acidopholus (sp?) mixed into his syringe food to help restore his good bacteria. You'll just need a pinch.
** Nature has a better way! Poop from a healthy guinea pig is the best probiotic ever! I take one "pellet" and mix it with water and feed it by syringe. It sounds nasty but it has saved more pigs than I can count. Any time I have a pig with any sort of intestinal upset I do this. It is known as "re-seeding the gut flora". There are other names for it too. The beauty of it is that the poop has a special chemical in it that keeps it from being digested in the stomach so it makes it down to the colon, where the problem occurs. - Sharlene Scheffer (sp?) RVT
Tue, 28 Sep 1999 This past weekend was good and terrible. On Sunday morning, he was inside his house not moving, shaking, and his eyes were half closed. I thought this was his last moments above ground.
So I picked up some Pedialyte and organic baby food. Rammed 13 cc of baby food carrots and 5 cc of Pedialyte into him. Couple of hours later he sprang back to life. So for the rest of the afternoon and throughout the night we force fed him every 3 hours.
Yesterday evening I pressed my vet to take another urine sample. Results were that his bladder returned to normal size and his white cell count was down indicating the urinary tract infection was gone. He wanted to keep Patches on the sulfa for another 5 days. I told him the medication Patches is taking to save his life may end up killing him because of lack of appetite. Essentially, Patches has not eaten a normal meal since Sept 5th. Reluctantly, he agreed to stop the dosage.
So Patches was given another subcue treatment of hydra, vitamin C and B complex. We got him home last night and watched him eat 3 pieces of lettuce and proceed to make two tiny beans!, talk about excitement in the household.
It's been a long 3 1/2 weeks. If he continues to do well on Friday, I will raise the victory flag then.
Tue, 28 Sep 1999 It's extremely important that he keeps eating. This is a part of a quote: "In fact, a long fasting period can cause stress in the guinea pig, and lead to a buildup of toxins in their body." ...And you're right, the spirit of the pig is tantamount to recovery. Some will give up the ghost right away, others will fight to the bitter end. It sounds like you have a fighter. Give him a couple of days off the med, and then try another pee test. If the problem is recurring, he can always go back on. Ask your vet about vibravet?... if it is effective against this infection. Our pigs love it and it doesn't affect their appetite.
Wed, 29 Sep 1999 Patches is eating with much more enthusiasm and regularity. He still has a strong preference to Romaine lettuce and Timothy hay and is not interested in carrots and broccoli. He has lost so much weight that I did another 15 cc force feeding last evening of carrots and apples. Hopefully that will be one of his last, although he takes the syringe feeder quite well.
He seems to still be interested in M&M beans, is that normal? He did not eat them before he got sick.
- Guineapapa & Patches
Wed, 29 Sep 1999 The interest in M&M beans is normal. When the sulfa is completely out of his system, this interest will subside. Weigh him daily to make sure he's gaining and keep the handfeeding up.
I would aim to get him to gain an ounce a day. You'll go up and down with the pooping, of course, but if you can get that much down him you'll be well on your way.
Thu, 30 Sep 1999 So here's the update:
I am hand feeding him 18cc of carrots, applesauce, and Pedialyte morning and evening.
He is eating his morning snack and dinner but is still fussy about hard carrots but loves grass from our yard and M&M pellets still. I found some compressed Timothy hay cubes at the store which he just loves.
I think the approach I will take over the weekend is to feed him less but more often.
Sat, 02 Oct 1999 Patches continues to improve impressively. His appetite is strong, eating anything near his little guinea-mouth. He has stopped eating M&M pellets, assumed to be a good sign. We have also decided to try not hand feed him but to offer more food that he can eat on his own.
Wed, 13 Oct 1999 Patches is in critical condition.
I left yesterday for work and he was happy and eating like a truck driver. I got home last evening and he was curled up in his house. He looked like he was in a lot of discomfort so I rushed him to the vet.
It seems that he has either an intestinal blockage or that his intestines are knotting themselves up. Either option is grave. So last night, on the advice of the vet, Patches was given morphine to ease the pain. The blockage is holding back both food and air in his system. The vet said there is a slim chance that Patches may be able to pass the blockage overnight.
The vet and I came up with the following 12 hour treatment procedure:
A 15 cc sub-cue treatment of water.
An oral dosage of mineral oil in hopes that both the water and the oil will loosen the blockage.
The vet went back to the hospital last night at midnight, at my request and expense, to make sure he was not suffering. This morning if Patches has not passed the blockage, he will be put to sleep. The vet said his chances of surviving the night is 10%.
I have given the vet permission to put him to sleep without calling me first. If Patches is suffering, I do not want it to be prolonged.
Thu, 14 Oct 1999 Everyone is more confused about Patches than ever. Let me summarize:
So the vet goes to give Patches the big shot and behold the little trooper passed the blockage yesterday morning. Not yet ready to claim victory, the vet tries some food....eaten in 2 seconds flat. Patches continues to poop and eat all day long.
So I call at noon to get the official 'sad' news and instead he says Patches may go home. ???????????
I run to get him last night......and this morning he is alert and happy like nothing happened. ?????????
The vet's comment to me was, "That is one tough %^#!Z$* guinea.....".
He beat a 1 in 10 odds of surviving the night, Vegas would not had even bet on that horse.
Tue, 19 Oct 1999 Patches is doing well. He is gaining weight slowly but filling out nicely in his face.
The 'morphine' shot helped Patches alot; he was only given one.
Tue, 19 Oct 1999 So glad to hear about Patches although that intestinal blockage still concerns me. Why so soon after being sick - I can't help wondering if there's any connection.....
Tue, 19 Oct 1999 Patches and the whole gang are doing well this evening. I asked the vet whether he thought there was a connection between Patches' infection and his blockage. He thinks the combination of him getting off the sulfa and feeling better with the shot of vitamin B complex, made the little guy gorge himself with food.
Wed, 27 Oct 1999 by the by - how much pedialyte? How often? How much did Patches weigh or did his size have no bearing on dosage?
Thu, 28 Oct 1999 Patches continues to do well, gaining weight and bomping M&M whenever she lets him.
The pedialyte option was my idea from desperation, when in Sept Patches took a turn for the worse. His eyes were half closed and he was shaking.
So I ran down to the market and found myself in the baby aisle. I saw it and read that it hydrates babies. I figured I had nothing to lose; theorizing that dehydration may be causing Patches to act slurry.
So I raced home and gave him 6 cc every 4 hours for 8 hours. By the end of the day he was more alert and interested in food. My vet agreed that it most likely saved Patches that morning. One can usually get pedialyte at larger drugstores or grocery stores that stock baby food etc. Patches weighed about 1.3 lbs at his worst. He is just over 1.75 now.
I have run into bloat occurring in recovering pigs few times since Patches' case: An extremely ill pig slowly but steadily recovers only to come down with bloat a couple of weeks after the owner thinks he's out of the woods. It happened to our boar, Willie, after he was very ill a year ago. Only quick action at the vet with Reglan (following treatment instructions from Vicki of Jack Pine Guinea Pig Rescue) saved him. I have since begun to believe (absolutely no proof, just a hunch) that this condition is connected with handfeeding. I suspect that a constant diet of pureed food leads to "lazy" intestines. When the pig starts eating regular food, the intestines which are used to soft, easily digested food have trouble with the new and sudden change of consistency. This is why I believe it is so important to ensure that while handfeeding the pig gets as much fibre as possible. Again, I have absolutely no proof that this is true - just a hunch.
On the subject of handfeeding, Dr. Connie Orcutt responded to a question about pedialyte, Ensure, fibre and diarrhea:
Pedialyte only provides glucose, electrolytes, and fluid - it is not nutritionally complete. Ensure is more complete, but it is not formulated for herbivores requiring high amounts of fiber in their diet. Fiber actually helps the gut to function properly in gps - it does not cause diarrhea. It is extremely important to administer complete nutrition to any gp that is anorexic or that has a decreased appetite. The product that has been formulated for just that purpose is Critical Care for Herbivores from the Oxbow Hay Co. Their webpage is www.oxbowhay.com. The animals that really seem to like this formula are guinea pigs - in fact, sometimes we have to come up with ways to "wean" them off the gruel and back onto their regular diet. In lieu of that, I would grind dry gp pellets in a coffee grinder and mix with water and veggie baby food.
Note: the article on this page was generously contributed by Pinta.