Midnight's Medical Topic

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Sef
I dissent.

Post   » Sat Jun 25, 2022 10:19 am


I'd be interested in seeing the x-rays. It sounds like your vet was pretty thorough.

Dehydration would be based more on skin elasticity, and often the eyes will look dry, dull or sunken. I'm a big believer in fluid therapy for ill or poorly pigs, especially in those who have stones that could be causing decreased renal function---which can apparently happen with ureteral stones in particular. Did the vet mention that as a possibility?

NSAIDs like Metacam should not be used concurrently with steroids (like Prednisone), so you will definitely want him off it for a few days before starting the Pred if you decide to go that route---as your vet suggested.

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AviN4
Supporter in '21

Post   » Sat Jun 25, 2022 10:36 am


I'll follow-up with the vet office for the x-rays and will post it ASAP. I'll also get the exam notes to see how the dehydration was diagnosed.

I probably should have agreed to the IV fluids. But as I expect you can understand, I have reservations about trusting vets, and didn't know on the spot whether it was a good idea. I also worried it might be unnecessarily stressful for him and might add unnecessarily to the $340 bill. I'll administer more water during feedings and hopefully that'll help.

Dr. D didn't mention stones potentially decreasing renal function. She thinks the stones are in the bladder so maybe that's why she didn't think to mention it. I suspect she didn't conclude that independently but read it from Dr. B's exam notes.

And yeah I've stopped the meloxicam and plan to wait a few days before starting the prednisone (if I do). As I said, I don't think the meloxicam was doing any good anyway.

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AviN4
Supporter in '21

Post   » Tue Jun 28, 2022 8:15 am


I've made a mistake and accidentally gave Midnight a 10x overdose of prednisone on his first dose last night. I don't notice any new symptoms or change in behavior this morning, and I'm hoping I didn't cause him significant harm.

A few days ago I wrote:
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.
So last night, 3 days after stopping the meloxicam and no obvious signs of improvement with the Reglan and simethicone, I gave him his first 1 mL dose of prednisone. Then this morning I woke up with a memory of the vet technician pointing to the 0.1 mL line on the syringe. So I took another look at the bottle and it says "GIVE .1 ML BY MOUTH EVERY 12 HOURS." The dot was tiny and I missed it.

I still don't know the mg / mL concentration. My best guess is that it's 10 mg / mL and that I gave him 10 mg instead of 1 mg.

I'm trying to get in touch with the vet office to confirm the mg / mL concentration and how to proceed.

User avatar
Lynx
Celebrate!!!

Post   » Tue Jun 28, 2022 8:27 am


I think the vet will be reassuring regarding the initial high dose. Sorry it is causing you worry but glad you caught it.

p.s. vets are SUPPOSED to write a dose of 0.1 ml with the 0 in front of the .1 so you notice the decimal! This would have been an error on their part if they did not make it clear.

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AviN4
Supporter in '21

Post   » Tue Jun 28, 2022 8:32 am


Good to hear you expect it to be OK. I'm still trying to get in touch with the vet office. Their hours seem inconsistent these days.

A few things went wrong here that caused the mistake. Both myself and the vet could have exercised more care in preventing it.

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AviN4
Supporter in '21

Post   » Wed Jun 29, 2022 12:37 pm


An update from Dr. D: The prednisone was actually 3 mg / mL. So the overdose wasn't that bad: only 3 mg rather than the intended daily dose of 0.3 mg. She said if there were possible side effects of the overdose would be a further decrease in appetite or bloody stools. I don't see any bloody stools. His appetite is still poor but it's not obvious whether or not the prednisone overdose has made it worse.

Midnight was was 807 grams this morning. It's not looking good. At best I've slowed the decline down a bit, but even that is unclear.

Image
(Y axis starts at 20 oz.)

I've been syringe feeding him roughly 3 times per day, 15 mL of Critical Care mix and 15 mL of water with each feeding. But I don't think it's enough calories to maintain his weight, and I think it's mostly just offsetting the food he would eat on his own. (He seems noticeably less interested in food for many hours after each syringe feeding.)

I've been giving him Reglan 0.25 mL and simethicone 0.15 mL during each feeding since 6/24.

On 6/24, I stopped the meloxicam and Tylenol and on 6/27 I started prednisone twice per day. The first dose was a mistaken 3 mg dose but every dose after that has been 0.3 mg.

I asked Dr. D about next steps if the prednisone doesn't seem to help within a few more days. She said we're running out of options and she could refer me to a specialist to get blood tests. She said she still thinks some kind of cancer is most likely. I asked about increasing the prednisone and she said we could try increasing it a little, from 3 mg to 4 mg every 12 hours. I also asked about cyproheptadine. She said she usually prescribes Reglan or cyproheptadine but not both. But if the Reglan isn't working after a week or so then we could try cyproheptadine.

Here are the x-rays. I can also share them in higher resolution if that would be helpful.

In previous x-rays, it looked like he only had stones in one of his ureters. Now it looks to me like he has stones in both. Not a good sign.

Image
Image
Image

I should get the exam notes sometime today.

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AviN4
Supporter in '21

Post   » Wed Jun 29, 2022 4:14 pm


Correction here:
I asked about increasing the prednisone and she said we could try increasing it a little, from 3 mg to 4 mg every 12 hours.
I meant to write:
I asked about increasing the prednisone and she said we could try increasing it a little, from 0.3 mg to 0.4 mg every 12 hours.
I would like to think I've learned my lesson about overdoses...

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Lynx
Celebrate!!!

Post   » Wed Jun 29, 2022 10:25 pm


Glad you added that correction!

He looks so lanky. I am sorry to hear his weight is going down again. I hope it stabilizes soon.

User avatar
Sef
I dissent.

Post   » Thu Jun 30, 2022 11:02 pm


Agree that he looks very thin. I also tend to think those are ureteral stones and not in his bladder. If that's the case, the obstruction can easily point to pain and gradual loss of kidney function---which can in turn lead to a wasting away of muscle mass and weight loss. Kidney failure can also affect appetite as a build up of uremia causes food to taste or even smell different. I'm surprised that the vet doesn't want to explore that possibility further. It seems a little more likely to me, based on these images and what you describe, than cancer. But I'm not a vet; this is just from past experience with one of my own guinea pigs who ended up with stones in both ureters, and also another pig (there might have been two) years ago who suffered from chronic renal failure without stones.

Without looking back, how is his fluid intake?

And remind me, why is he on a motility drug?

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Lynx
Celebrate!!!

Post   » Fri Jul 01, 2022 7:43 am


This is Sef's guinea pig (from the stones page):

Image

Most of the ureter stones I've seen look like a string of beads. The narrowness of the opacity looks perhaps confined to a ureter on one side.

User avatar
Sef
I dissent.

Post   » Fri Jul 01, 2022 11:29 am


I noticed that, too, Lynx and wonder if maybe that could be sediment or sludge rather than (or in addition to) a stone. It does not look well-defined.

Thanks for posting the image.

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AviN4
Supporter in '21

Post   » Fri Jul 01, 2022 5:11 pm


I had Midnight euthanized today. He was losing weight rapidly, even with aggressive Critical Care feeding and multiple drugs. Without the Critical Care, he would nibble some food but seemed to lose weight even faster. None of the drugs seemed to be helping either. His prospects looked bleak and I wanted to minimize aggressive feeding, aggressive medical care, prolonged suffering, and risk of an emergency that causes extreme suffering. Also, the past few weeks have been especially draining for me. I think and hope that it was the right decision for both of us. I expected I'd need to euthanize him sometime late last year, and I'm surprised that went as long as he did with a stable weight and minimal symptoms.

Moon and I will miss Midnight greatly. I do hope Moon copes okay. I know it's bad for guinea pig mental health to be without a friend, but I don't think adopting another guinea pig is the right decision for me.

I'm immensely grateful for all the numerous hours of caring, informative advice you've all provided for me and Midnight for the past 3+ years. Especially Lynx, Sef, bpatters, and Talishan. Thank you.

Sef, to answer your questions:
  • I agree renal failure seems to fit the symptoms and I asked Dr. D about it. She said she would expect to see an enlarged kidney on the x-rays. Maybe she's mistaken -- I don't know. I actually didn't ask all that much about it until today because based on what I've learned, if his symptoms are caused by ureter stones resulting in kidney failure then his prospects seemed especially bleak. Dr. D concurred with this.
  • If I understand correctly, the Reglan was to help with gas Dr. D saw on the x-ray in his GI tract. I was also giving him simethicone for that reason.

User avatar
Sef
I dissent.

Post   » Fri Jul 01, 2022 5:40 pm


Oh no, I am so sorry, AviN4. You worked so hard to give him good quality of life all the way to the end, and he was so lucky to have had such a dedicated and caring piggy person who clearly adored him. My heart goes out to you, and also to little Moon. I know it's so incredibly hard to make that decision, but when the prognosis is so poor and their little body is failing them, it truly is one of the most loving things we are ever able to do for them.

Wishing you peace. Godspeed, little Midnight. Run happy, healthy and free at the Rainbow Bridge.

bpatters
And got the T-shirt

Post   » Fri Jul 01, 2022 8:51 pm


I'm so sorry you lost him. Do take comfort in the fact that he's not in pain any more.

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Lynx
Celebrate!!!

Post   » Fri Jul 01, 2022 10:28 pm


I am so sorry for you, AviN4. Even when it is the right decision, euthanizing a pet is so difficult. We tend to second guess ourselves. Midnight had such a good life with you.

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ItsaZoo
Supporter in 2022

Post   » Sat Jul 02, 2022 2:00 am


My condolences on your loss. Midnight had a good life with you and I think you made the right choice to prevent him from suffering. It is exhausting caring for these little ones when they are ill. Take care of yourself and Moon.

Lisa12

Post   » Sat Jul 02, 2022 8:00 am


I am very sorry for your loss of Midnight, too:(. Run free, little king!

Talishan
You can quote me

Post   » Sat Jul 02, 2022 2:45 pm


Avi -- I just now saw your PM. I am very, very sorry for Midnight, for Moon, and for you. My empathy and comfort to you.

Godspeed and safe passage, Midnight. You will always be loved and always be remembered. Blessings and great joy, now, to your spirit and being.

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AviN4
Supporter in '21

Post   » Sun Jul 03, 2022 6:43 am


Thanks everyone for the kind words.

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