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Specialist Our Guinea Pig, Apple, Is Poorly.

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Chris24

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Hi All,
Hope you can help. We have a poorly Guinea Pig named Apple (female, approx 4 years old) who has been back and forth to the vets for the past week. Here is the story so far (apologies for the length but we did not want to miss any pertinent information):

02/05/2015
We first noticed that Apple was very subdued in her cage, sitting in a ball all fluffed up and refused to eat. She is normally very adventurous and full of life so this was unusual. As we went to take her out, we noticed diarrhoea in the cage. Apple appeared to be a lot thinner than normal so we feared the problem had been going on for a few days (minus the diarrhoea).
Apple was taken to the vets immediately and her weight had dropped from just over 1kg to 850g. Apple was very gassy and her tummy was distended. She was administered with IV fluids and the following medication schedule was started:

• Oxbow critical care fine grind: 3 tablespoons over 24 hours with water (24/7 syringe feeds every 4 hours)
• Septrin: 0.27ml twice a day
• Fibreplex: 1mg three times a day

03/05/2015
After 24 hours Apple had not opened her bowels so we were prescribed metoclopramide 0.43ml twice a day for four days and to perform regular tummy massages. Apple began to pass faeces in the early hours of the morning but they were tiny, sticky and unformed.

04/05/2015
Apple was livelier, pooping throughout the day. Poops are becoming slightly more formed but still sticky. Apple became more interested in certain foods (curly kale), but was unwilling to eat.

05/05/2015
Apple started to struggle more when being syringe fed and she is brighter in herself. Ate one piece of curly kale and interested in hay, but only nibbling and also drinking independently from water bottle (but only a small amount).

06/05/2015
Apple is eating tiny amounts of Kale and drinking from water bottle. Poops are still small, but almost formed. We decided at this point to go back to the vets. On examination the vet discovered her lower abdomen was hard, but intestines seemed to be empty. A kidney and ovary scan was advised. Also advised that the issue may be related to a teeth problem.

07/05/2015
Kidneys and ovaries were scanned under anaesthetic and a full check of the mouth was performed. No teeth problems found – no ulcers and no foreign bodies located. The front teeth were trimmed at this point as a precaution. Following ultrasound and x-ray scans, Apple was diagnosed with early stage polycystic ovaries but the cysts were tiny and we were assured they would be causing no other clinical symptoms. Nodules were detected on her spleen – which we were told could be reactive or neopathic.
Medicine provided:
• Loxicon 0.25mls twice a day
• Recovery plus food – 20g in 90mls of water over 24 hours for two days then back onto oxbow fine grind
• Continue with metroclopramide, septrin and fibreplex as above

08/05/2015
We noticed Apple was unable to eat curly kale this morning. She was very interested in it, but couldn’t seem to chew the food. Took Apple back to the vets for a check-up following yesterday’s procedure. We asked if it was possible that the front teeth were cut too short – the vet said this could be a possibility.
We asked them if it the reluctance to eat could be caused a misaligned jaw or elongated roots. The jaw was checked and no problems found, we were told elongated roots were not a problem as her back teeth were really short.
Apple was able eat kale providing it was held for her. She also managed to eat 2-3 nuggets and some hay. Poos are back to normal size and shape but still sticky.

09/05/2015
Still on syringe food, but able to eat a small amount of nuggets, hay and some curly kale unassisted. However, when being syringe fed or eating nuggets she sometimes looks like she is retching – perhaps unable to swallow the food?
Although Apple is starting to eat food independently, she eats VERY slowly compared to normal.

10/05/2015
No further change, still retching when eating nuggets. Apple is generally subdued and spends a lot of time sleeping although she gets more excitable when treats are present.
Her weight has been maintained at 850g throughout. She has also been urinating normally throughout, although her urine is orange in colour (which we presume is a side-effect of the fibreplex).
We are seeing the vets again on Tuesday but felt at this point we need a second opinion as something is still not right with her. The retching and slow eating are particular concerning and we are still having to syringe feed her in order to maintain her weight.

I have uploaded a video to YouTube showing the retching – I hope it helps.


Thank you for taking the time to read this.

Chris and Kim
 
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Hi and welcome!

Could you please add which country you are in as we have got members from all over the world. Click on your username on the top bar, then go to personal details and scroll down to location. This will help us to take into account what is available/possible for you including medical brands and make any advice more efficient.

I am very sorry about your struggles. Have the teeth, especially the premolars been checked? How is the weight loss been (please weigh any ill piggy daily at the same time instead of just weekly as with all other piggies). Problems with swallowing can also be a sign of growing weakness, please feed little but often and only as much as the piggy can swallow easily, which can be as little 0.1 ml. I would strongly recommend to mush up the pellets, so she can eat them more easily. Please continue to hand feed as much as she will take in the meantime to keep up her strength as much as possible. If you wish, give additional vitamin C and probiotics, too.
You may find the tips in our hand feeding guide can help you a bit more on that score: https://www.theguineapigforum.co.uk/threads/complete-hand-feeding-guide.115359/

Please do not feed any vegetables, especially not cabbages like kale, to any guinea pig with digestive problems. Always wait until the poos have firmed up for ideally at least 48 hours, then start with fresh herbs for minerals and vitamins and introduce any other veg only slowly and gradually in small quantities.

I am tagging our dental expert for you @furryfriends Excellent Adventure Sanctuary as well as our medications specialist: @Pebble
 
Hi Wiebke,

Many thanks for the quick response. I have updated my location details (Essex, UK). The vet checked both front and back teeth whilst under sedation. We are providing her with extra vitamin C in her water bottle but no probiotics at present.. can you recommend any suitable ones?

The weight loss was first recorded at 850g (dropped from 1KG) following the original diarrhoea, and she has been weighed daily since. The numbers are 855,865,856,853,864,858,885 (we think something was wrong the scales on this one) and 858g today.

We'll stop with the Kale for now. The bloat has gone down significantly since the beginning and her poops are almost formed. It is the retching, eating problems and fatigue that concern us the most at the moment.
 
I just noticed fibreplex is listed in the hand feeding guide provided, which Apple is currently on. Is this sufficient to cover both Vitamin C and Probiotic needs?
 
Personally, I would add both a pinch of probiotics (at the worst is just a bit of extra fibre) and some vitamin C to help boost the immune system. You could try and see whether 0.2 ml of metatone could perk her up a bit; it sometimes does with fatigued/weak piggies.

It is encouraging that at least the weight is stable, so she is getting enough food to keep her ticking over. Your vet seems to have covered all the obvious avenues.

It is always very upsetting when your piggy is so ill and not recovering without there being any obvious cause, but you are doing everything that any good owner and vet can do.

Thanks for updating your location.
 
The only thing I can think of to add is the possibility of oral thrush as it can make them move their mouth the way she does in the video. It could be a side effect of everything else going on though.

Am sorry, she is poorly.
 
Thank you for the replies. I'll certainly see about getting some metatone in her and i'll order some daktarin oral gel to go with her existing medications.

The vet has been very good so far and very open to suggestions - we have the option of an exotics referral if required. I just felt at this point it was wise to get some other opinions before deciding what to do next.. hopefully, if it is just fatigue the problem will sort itself out give time.. fingers crossed!

I'll post further updates as they happen. Thank you all once again.
 
Thank you for the replies. I'll certainly see about getting some metatone in her and i'll order some daktarin oral gel to go with her existing medications.

The vet has been very good so far and very open to suggestions - we have the option of an exotics referral if required. I just felt at this point it was wise to get some other opinions before deciding what to do next.. hopefully, if it is just fatigue the problem will sort itself out give time.. fingers crossed!

I'll post further updates as they happen. Thank you all once again.

Please see whether the experts I have tagged for you have got any further suggestions.
 
I have seen this a number of times, and we have successfully treated many, although some have just worsened. I think the problem is that once food is in the mouth, saliva is formed which the piggy then struggles to swallow, and they start gagging and retching. The drug, Itrafungal, has been the most successful in dealing with piggies with this condition. Although it is an antifungal drug, in each case the guinea pigs mouth hasn't shown signs of classic oral thrush, but the drug has still had the desired effect.
 
Thank you furryfriends, I will get some Itrafungal from the vets as soon as it opens tomorrow morning. You are right in that Apple wasn't showing any signs of thrush from the oral examination the vet carried out a few days ago. How quickly should we expect the Itrafungal to take effect? Also, what dosage would you recommend for this treatment?
 
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OK just an update on this. We attempted to feed apple some more nuggets this afternoon. She was very keen to eat them and manage to crunch through a few of them but now is unable to eat them properly. She picks them up in her mouth and goes through the motions to eat but then the nugget just drops out in an intact form! It's almost like she hasn't the jaw strength to crunch on them.
 
OK just an update on this. We attempted to feed apple some more nuggets this afternoon. She was very keen to eat them and manage to crunch through a few of them but now is unable to eat them properly. She picks them up in her mouth and goes through the motions to eat but then the nugget just drops out in an intact form! It's almost like she hasn't the jaw strength to crunch on them.

Just try and see whether she can cope with nuggets that you have mushed with some boiled, cooled water.
 
Will do, we'll have to syringe feed them this way as she is not interested eating them mushed up on her own accord.
 
I know it's a long way, but could you consider getting Apple seen by Simon or Kim Maddock at The Cat and Rabbit Clinic, here in Northampton. They are the vets that we use at the Sanctuary, and we wouldn't be able to do the work we do, without them. They're amazing guinea pig vets, and they have worked wonders with guinea pigs from all parts of the country.
 
Thank you, we will certainly bear this in mind.

If Apple doesn't pick up from the itrafungal meds then at this point we will take her to Vedra at the Cambridge Cavy Trust (on recommendation from another source). Cambridge is quite a bit nearer for us.
 
Having read through your detailed first post (it is very well-documented and very helpful for us so thank you) - it is likely that part of the developing problem is that the incisors were cut a bit too short. Nevertheless you have a poorly piggie who for some reason is not able to manipulate food in her mouth, is not getting sufficent fibre into her and is also developing gassy signs as a result (good idea to cut out veggies at the moment and maybe also consider gut motility meds cisapride and zantac - thankfully more vets are recognising and reaching for these meds as an essential part of the "supportive gut motility care package" for poorly piggies in addition to syringe feeding)

Whilst there may now be a problem with the mouth/dentition atm, this may not necessarily be the PRIMARY cause....in many cases it is pain from another condition (eg stones, ear infection or even an indeterminate systemic bacterial infection) that can be the original trigger event.

Is she still on septrin? How old is Apple?

I find it significant to note that one of the first symptoms was diarrhoea - this is often indicative of an infection going on somewhere (possibly in the jaw, possibly elsewhere from my own personal experience). Another significant symptom is the orange wee - this has only ever occured in my pigs who are either on septrin (the yellow colouring) or on other abx but all have an undetermined infection somewhere

As well as getting her oral cavity/teeth thoroughly checked - with the possibility of getting intrafungol prescribed (but many vets will not do so - even my own very experienced exotics vet will not do so without a positive culture result) - there needs to be a thorough veterinary exam to try and identify the initial problem that sparked this off.It does sound liuke your current vet has reached the limits of their cavy-experience.

I have personally transported forum members piggies to Cambridge to see Vedra over the years....and also to Simon in Northampton ...
In Apple's case, given the symptoms that she is showing in the video. (not retching - just can;t manipulate her food properly and swallow it) and the other indicators........I would strongly urge you to consider making the trip to Simon and Kim in Northampton as soon as you possibly can.

Sorry if this sounds blunt - but from past experience I am worried you may be running out of time for Apple and her specific needs would best be handled by Northampton rather than anyone else.
 
If you need help to get your piggy to Simon at the Cat & Rabbit clinic the forum might be able to organise a piggy train cross country. There are a few of us that help out in this way. Please consider Furryfriend"s suggestion carefully; time really is of the essence when dealing with dental or weight loss issues & Simon is a wonderful vet :)
 
Hi Pebble, thank you for your input.

To answer some of your questions:

Apple 4 years old (approx) and is currently still on all medication listed in the original post (including septrim). Apple is on metroclopramide at the moment, is there any advantage for her to be on Cisapride and/or Zantac?

I am slightly confused on the Intafungol recommendation as furryfriends advised that this would be a good idea based on the current symptoms. What harm could be caused by putting Apple on this anti-fungal med if there is no fungal infection present?

One thing I completely forgot about with all the stress, is that we requested a fecal sample to be analysed when the problems first began. We should get the result back on this in the next day or to, I presume this will help in the diagnosis if the problem is fungal or bacterial?

Both Vedra and Simon/Kim seem very knowledgable cavvy vets, so I am not sure of the inherent advantage of using one over the other? Obviously we want the best care for our piggie, but other than personal recommendation, can you provide more specifics on why Northampton would be a better fit in this case?

Apple has perked up significantly in the past few days and seems quite well (comparitively) to how she was this time last week. We are continuing to maintain her weight and she has the willingness to eat by herself, it seems like this eating issue is the final hurdle to getting her 100% well again... so it is worrying that you suggest she is still at deaths door, though this is duly noted and we will seek to have Apple looked at again more urgently.
 
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Zantac and cispride are a better option for gut stimulation. Metoclopramide tends to work mainly on the fore gut (stomach mostly) where as the other two (in combination especially) will cover her entire gut system.

Good luck with whatever you chose to do.

x
 
Please note that Vedra is not a qualified vet & as such may not be able to prescribe meds that are appropriate in your case. I have been to Vedra with my own piggies in the past before I found a knowledgable vet, but there are many vets now who have a lot of experience in treating piggies. Guinea pigs can very quickly deteriorate I have experienced this myself; one of mine was fine at midnight & when I woke up she had full blown bloat & Vedra couldn't save her. Your piggy isn't in immediate danger but seeing a piggy savvy vet promptly is better than trying other avenues first.
 
Hi Pebble, thank you for your input.

To answer some of your questions:

Apple 4 years old (approx) and is currently still on all medication listed in the original post (including septrim). Apple is on metroclopramide at the moment, is there any advantage for her to be on Cisapride and/or Zantac?

Yes - cisapride and zantac work well together on different areas of the gut to keep it moving. Metoclopromide only works on the fore-gut and is now considered to be a bit of a sledgehammer

I am slightly confused on the Intafungol recommendation as furryfriends advised that this would be a good idea based on the current symptoms. What harm could be caused by putting Apple on this anti-fungal med if there is no fungal infection present?

Many oral anti-fuingal drugs are processed by the liver ...with harmful results in small furries. Their use is therefore only justified if there is a case of PROVEN fungal infection as otherwise the risks outweigh the benefits. No self-respecting vet would prescribe these drugs speculatively...they would prescibe because they believe there is justifiable due cause

One thing I completely forgot about with all the stress, is that we requested a fecal sample to be analysed when the problems first began. We should get the result back on this in the next day or to, I presume this will help in the diagnosis if the problem is fungal or bacterial?

Possibly - but not all faecal sanples give a definitive result (said from experience of testing ALL my piggies poops!)

Both Vedra and Simon/Kim seem very knowledgable cavvy vets, so I am not sure of the inherent advantage of using one over the other? Obviously we want the best care for our piggie, but other than personal recommendation, can you provide more specifics on why Northampton would be a better fit in this case?

Let's be VERY CLEAR on this - Vedra is NOT and NEVER HAS BEEN a qualified vet. Over the last 20 or so years, she has provided a laudable means to inform guinea pig owners and vets on proper guinea pig health and is to be respected for her contribution. But time/knowledge/vets/legislation have moved on You need to see a qualified vet who is PROPERLY LICENSED to treat Apple otherrwise you could be putting yourself in a position of breaking the law.

Apple has perked up significantly in the past few days and seems quite well (comparitively) to how she was this time last week. We are continuing to maintain her weight, it seems like this eating issue is the final hurdle to getting her 100% well again... so it it worrying that you suggest she is still at deaths door, though this is duly noted and we will seek to have Apple looked at again more urgently.

Thank you for considering my post - I don;t ever like to scaremonger, bully or threaten..All I ever try to do is provide posters with the benefit of my experience and knowledge. I have responded in the quote to the points you have raised - you will need to click on the quote panel to expand it to see my answers. Also - I can now see that other people have already addressed some of the points
 
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Thank you for considering my post - I don;t ever like to scaremonger, bully or threaten..All I ever try to do is provide posters with the benefit of my experience and knowledge. I have responded in the quote to the points you have raised - you will need to click on the quote panel to expand it to see my answers. Also - I can now see that other people have already addressed some of the points

Thank you Pebble and Poppy's Mom I really appreciate your help and guidance on this. We just want the best care for our piggies, so with that mind we will take her to Simon further tests as soon as we are able to.

Poppy's Mom, you mentioned a piggy train - can you advise how this normally works?
 
For future reference I have uploaded another video of Apple struggling to eat nuggets. We are currently syringe feeding these in mashed-up form along with the critical care.

 
It won't let me view the video as it says it's private. You are doing the right thing by getting Apple to Simon. Please ring the practice this morning. They open at 8.30 am. If you are offered an appointment to see Kim (Simon's wife) then go for it. She is an excellent vet too, and also good with guinea pig teeth.
 
I have changed the video privacy setting so it should now be viewable now.
 
Thanks! It's very clear you have a guinea pig who wants to eat and is still looking very well in herself. However, that can all change very quickly, so I think the sooner you can get an appointment the better. If you would like a chat on the phone my contact details are on the website www.teasnorthampton.co.uk or check out our Facebook page.
 
Thank you Pebble and Poppy's Mom I really appreciate your help and guidance on this. We just want the best care for our piggies, so with that mind we will take her to Simon further tests as soon as we are able to.

Poppy's Mom, you mentioned a piggy train - can you advise how this normally works?
@Chris24 by Piggy train I mean that a few of us members here can organise a relay across the country to get piggies to Furryfriend's & Simon's if their owners can't drive or can't get over to Northampton for some reason. There might be several volunteers that will take your piggy from one point to another to get her to Northampton, should you have trouble getting over there yourself.
 
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