Midnight's Medical Topic

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AviN4
Supporter in '21

Post   » Sat Jun 18, 2022 8:02 am


Midnight was doing surprisingly well for around 9 months. But then, during a 5 day vacation during which I had a pet sitter feed them, his weight rapidly declined. He was stable for a week after I returned, but is now rapidly declining again.

Image
(Note: The Y-axis starts at 30 oz, not zero.)

In terms of his behavior, he seems to be spending more time in hiding, and expresses reduced enthusiasm for food. He is definitely eating sometimes though, including some hay.

I had previously stopped the meloxicam since he was doing fine. But after I saw his weight loss had resumed, I resumed the meloxicam at 0.15 mL daily of 1.5 mg/mL. A few days ago I increased it to 0.15 mL twice per day. As I understand it this is a low dose for guinea pigs, especially one that is reaching his end of life. So I plan to continue increasing every few days until I see improvement or reach the maximum safe dose.

I'm not sure if I should bother taking him to the vet, because unless it's a surprise new issue that is easily treatable, all a trip to the vet would do is add stress to everyone involved. I'm also in COVID-19 isolation right now and don't want to infect anyone unnecessarily. On the other hand, there is a small possibility of a new treatable issue.

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Lynx
Celebrate!!!

Post   » Sat Jun 18, 2022 10:10 pm


I am sorry about the weight loss. It does look significant. Changes can have unexpected consequences. I am hoping since you are back, his appetite picks up.

Have you considered doing any hand feeding? Getting things moving again (here, a motility drug could help if you are not seeing adequate poops) could help.

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Sef
I dissent.

Post   » Sun Jun 19, 2022 6:43 am


What is his actual weight? That dose for Metacam is not low, but I would agree that the need for good pain management should override the risks of higher NSAID use when they are in poor health/failing health and you want to keep them comfortable and eating well.

Is he staying well-hydrated?

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AviN4
Supporter in '21

Post   » Sun Jun 19, 2022 7:01 am


Lynx,

Midnight's weight stabilized for a week after I returned but then began rapidly declining again.

By hand feeding do you mean Critical Care via syringe? I haven't tried. A vet I spoke to last year suggested against it, since the goal was to make him comfortable and forcing him to eat would arguably make him uncomfortable. Do you think it's worthwhile anyway to "get things moving again"?

Relatedly, I have a bag of Critical Care in the fridge opened about a year ago. Is that safe to use until I get a new one in the mail (ETA 5 days) or should I toss it?

I've also tried some kind of pellet / carrot slurry, but on a tray, not via syringe. Moon was a little interested but Midnight was not.

How can I tell if his poops are adequate? He shares a cage with Moon so I can't tell who the poops belong to.

BTW, he's definitely eating at least some of the hay, pellets, and veggies that I feed them. But I think just less.

Sef,

Midnight was 889 grams this morning. I do see him drinking often, probably more than Moon. So I think he's drinking enough?

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AviN4
Supporter in '21

Post   » Sun Jun 19, 2022 7:27 am


Here's a photo of him (on the right) just now eating either pellets or oats. He still doesn't look underweight, though if his current weight loss keeps up for a few more weeks he will.

Image

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Lynx
Celebrate!!!

Post   » Sun Jun 19, 2022 11:05 am


You ABSOLUTELY have to hand feed when there are significant weight loss issues (barring a blockage of the intestinal tract). I highly disagree with your vet. ("A vet I spoke to last year suggested against it, since the goal was to make him comfortable and forcing him to eat would arguably make him uncomfortable.")

Having food moving through the digestive tract is terribly important.

bpatters
And got the T-shirt

Post   » Sun Jun 19, 2022 11:38 am


Ditto Lynx. And ditch that vet! Nothing will kill a pig quicker than not having food moving through its system.

Most pigs will adjust to regular syringe feeding, and even enjoy it. All of mine that were ever on extended syringe feeding quickly got to the point that I didn't have to hold their heads at all, and willingly took the syringe.

Make sure the pig is comfortable on a table in the crook of your arm. Hold the head firmly with one hand, and cover the eyes with that same hand. Put the syringe in the side of the pig's mouth, behind the front teeth and in front of the back teeth. Insert it about half an inch, then turn it to point toward the throat. Make sure it's far enough back for the food to get to the back teeth. If the pig chews, it's far enough back. If he spits it out, it's not.

Give about half to one cc at a time. You can give larger bites as the pig gets used to the process. Make sure the slurry is thin in the beginning. You can use a thicker mixture after a few feedings.

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AviN4
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Post   » Sun Jun 19, 2022 12:58 pm


OK, thanks for the feedback. I'll start hand feeding ASAP.

The vet who told me this was not my normal vet, but they are supposed to have expertise in guinea pigs. So that is concerning.

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AviN4
Supporter in '21

Post   » Mon Jun 20, 2022 3:54 pm


With regard to:
Have you considered doing any hand feeding? Getting things moving again (here, a motility drug could help if you are not seeing adequate poops) could help.
I wanted to see how much Midnight was pooping, so I put him in a separate cage for 2 hours with a variety of tasty food and water. I counted 5 poops, and one of them looks more like 3 stuck together. Not sure if it's appropriate to extrapolate, but if I do, I get 60 to 84 in 24 hours. Based on some googling that seems like an okay amount?

I took a photo: https://snipboard.io/437XTw.jpg (CW: GUINEA PIG POOPS)

I've looked at various guinea pig poop charts and it's hard to fit them into a category. They are not mushy, especially dry, or especially small. But some of them are in some weird shapes.

I also tried hand feeding yesterday and it was a struggle for all involved. I got in about 3 mL of Critical Care and then gave up. Today I did better and got in 9 mL in one sitting. I'll try again later. Unfortunately the syringe I have is a 3 mL syringe which is too large, but I've ordered some 1 mL syringes which should arrive on 6/22. I'll try to manage with this 3 mL one until then.

I've also have an appointment scheduled with a vet on 6/24.

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Lynx
Celebrate!!!

Post   » Mon Jun 20, 2022 10:31 pm


How has his weight done the last couple of days?

Quite a variety of poop! A little bit of everything. Important thing is there appears to be no blockage.

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ItsaZoo
Supporter in 2022

Post   » Tue Jun 21, 2022 1:49 am


If feeding is difficult, it may be the flavor. There are different flavors of Critical Care. I only have limited experience, but I found that mixing it with watermelon juice made it very palatable for my pig who loved watermelon. I also made smoothies with blended Critical Care, carrots, and hay. I used a Ninja smoothie blender. It was tasty enough that she ate it from a little plate, which is so much better than trying to syringe feed.

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AviN4
Supporter in '21

Post   » Tue Jun 21, 2022 8:04 am


Midnight was 890 grams this morning before any hand feeding. So roughly the same as 2 days ago.

I can try some experiments with different Critical Care recipes. But I suspect it's not that he doesn't like the taste, but just that he's not enthusiastic about eating. Also, the 3 mL syringe is hard to get into his mouth if he doesn't want to open it. I should be getting a shipment of 1 mL syringes tomorrow so hopefully that'll help.

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AviN4
Supporter in '21

Post   » Wed Jun 22, 2022 8:42 am


Midnight was 870 grams this morning before any hand feeding. I've been hand feeding him a Critical Care mix at a rate of 27 mL per day for the past 48 hours or so. My daily mix is around 2 tbsp of Critical Care with 5 tbsp of water. The hand feeding may be slowing down the weight loss but so far it does not appear to be stabilizing or reversing it. The hand feeding is becoming easier and I could try increasing the amount of food if that's likely to help "get things moving again." But it's not sustainable long-term and I'm concerned I might just be displacing food that he would eat on his own. If it causes him to eat less hay, then I think that could be especially bad for his teeth?

Could bloat be a cause or contributing factor? I don't notice obvious symptoms here but maybe it's mild or I'm not checking correctly? Is it worth giving simethicone or metoclopromide a try?

I am bringing Midnight to a vet on Friday. Is there anything specifically I should ask for in terms of tests, drugs, etc?

Midnight is at least 4-5 years old with stones (probably in his ureter) and arthritis, and I'm surprised he's been hanging on this long. I'm okay with euthanizing if/when he's probably suffering and unlikely to improve.

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Sef
I dissent.

Post   » Wed Jun 22, 2022 10:09 am


I didn't realize he is also dealing with stones. That is going to make the use of an NSAID like Metacam even riskier.

In terms of handfeeding, especially if his weight is low and he's battling painful stones and other issues, getting adequate food into him any way possible is critical to his survival. I'm just not a fan of withholding CC on the off-chance that an ill guinea pig can/will eat enough on his own to keep the gut moving and his weight from falling even further. Honestly, and not to be blunt here, but it sounds like potential tooth overgrowth is the least of your worries right now.

Note that there is a difference when we talk about bloating vs "bloat." Bloating is when the abdomen becomes distended with gas but they are still passing feces. Actual "Bloat" in guinea pigs is generally defined as severely reduced motility or full-scale stasis, which can be life-threatening. That said, if Midnight's motility has slowed and he's not producing much in the way of feces, it could be causing painful gas build-up that is contributing to his lack of interest in food---which is creating a Catch 22 situation. If that's the case, I would definitely discuss with your vet the possibility of adding Metoclopramide. Gentle massage can also help stimulate motility. I'd also have to weigh the pros and cons of pain management with Metacam vs. something easier on the kidneys (like Tramadol) but with the knowledge that other drugs may be sedating and could reduce gut motility even more.

If it were me, I think I'd want some x-rays to see what you are dealing in terms of those stones, the arthritis, and also his GI tract.

Just my $0.02.

Fingers crossed for you both.

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AviN4
Supporter in '21

Post   » Wed Jun 22, 2022 10:40 am


Thanks for the advice. I'll ask for x-rays.

With regard to insufficient feces, here's what I wrote a few days ago:
I wanted to see how much Midnight was pooping, so I put him in a separate cage for 2 hours with a variety of tasty food and water. I counted 5 poops, and one of them looks more like 3 stuck together. Not sure if it's appropriate to extrapolate, but if I do, I get 60 to 84 in 24 hours. Based on some googling that seems like an okay amount?
Given the circumstances, is it worth trying metoclopramide even if it's not obviously a bloating issue?

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AviN4
Supporter in '21

Post   » Wed Jun 22, 2022 2:28 pm


I received the 1 mL syringes and they made the hand feeding a lot easier. I was able to feed him 15 mL in one sitting. I don't think Midnight liked it but he was surprisingly cooperative.

In case it helps anyone, this is what I ordered. I cut off the tips with scissors, filed them down with a nail file, and then washed them with soap and water. I used 5 at a time. I also had another one (uncut) for water.

Midnight has also become much more calm about letting me pick him up. I no longer have to chase him around. I'm afraid this might be a bad sign, that he's lacking the motivation to run away.

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Lynx
Celebrate!!!

Post   » Wed Jun 22, 2022 10:02 pm


Glad you got the syringes. Increasing weight by hand feeding can be difficult. Stabilizing weight should be attainable.

Tons of thunderstorms here. Lights going out, coming back on. Torrential rain at the moment (counties to the near north have downed trees and widespread power outages). I hope your circumstances are more comfortable.

Sef gives excellent advice! (better than mine) Pulling for Midnight.

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AviN4
Supporter in '21

Post   » Thu Jun 23, 2022 7:34 am


Oh no! That sounds scary. Is your power okay now?

I'm in the NYC area and it's been fine here. Just light rain yesterday evening.

This morning before hand feeding Midnight was 875 grams. So it's been mostly stable for a few days. I just hope he starts eating enough again on his own.

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Lynx
Celebrate!!!

Post   » Thu Jun 23, 2022 2:32 pm


I hope he starts eating again too! Stressful for both guinea pig and caretaker when there are medical issues.

Never completely lost power (it would come back on after going out for a minute or so). But did lose internet last night! While I was on hold with Century Link this AM, it came back, so good for now. Some areas hit harder than others, here in central Virginia:
https://www.wtvr.com/news/local-news/severe-storm-power-outages-june-22-2022o

Quick note here - lost internet so had to come back later to post this!

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AviN4
Supporter in '21

Post   » Sat Jun 25, 2022 8:58 am


tl;dr The vet observed gas in an x-ray. Started Midnight on Reglan and simethicone. Also gave me prednisone but I don't know if that's a good idea.

I took Midnight to Dr. D on Friday. Same office as Dr. B (usual vet) but he's on vacation. Some updates from that:
  • She couldn't see anything wrong with his teeth, including his molars. As usual, seeing his molars was a challenge with food in his mouth.
  • She said Midnight had a heart murmur, but couldn't see anything wrong with his heart in an x-ray. So probably not relevant.
  • She observed he had cataracts (which I already knew) and said he appears mostly blind, so maybe that's been getting worse.
  • On an x-ray she observed that he had gas in his GI tract. She said it might be caused by inflammation, which might be caused by GI cancer or something else.
  • She said she saw evidence of dehydration (maybe on the x-ray?) and suggested an injection. I declined and said I would syringe feed more water during hand feeding.
  • She saw no major changes in arthritis or the stones. She, like Dr. B, said the stones were in his bladder. But I still think the ureter is more likely.
  • She prescribed Reglan 0.25 mL every 8-12 hours for motility for 7 days. The bottle doesn't say the concentration, but the standard seems to be 1 mg / 1 mL.
  • She prescribed prednisone 1 mL every 12 hours for inflammation (maybe caused by cancer) and for appetite stimulation, indefinitely as long as it seems to be helping. I asked about discontinuing the meloxicam (which I don't think is helping anyways) and she concurred that I should discontinue it and wait 3 days before starting the prednisone. The bottle doesn't indicate the concentration and I don't see a consistent standard. I'll ask.
  • I also asked her about simethicone. She concurred that it's a good idea and said I can use infant's simethicone. I've started administering 0.15 mL during Critical Care feedings, which I'm doing 3 times per day.
The Reglan and simethicone both make sense to me and I've started Midnight on both. But I'm skeptical about the prednisone. I'd be interested in getting the GuineaLynx expert opinion on this. In any case I've stopped both the meloxicam and the acetaminophen, which I don't think were helping anyways.

I'll work on getting the x-rays and will post them here.

Also, I don't think I should read too much into this yet, but Midnight's weight dropped 25 grams this morning to 845 grams, a new low. This was after a stressful vet visit and a Reglan dose yesterday.

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