Midnight's Medical Topic

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Lynx
Celebrate!!!

Post   » Fri Sep 03, 2021 10:16 pm


Okay. Since this was an emergency appointment, I take it this was not an exotics vet real familiar with guinea pigs?

If they are teeth problems, an xray, read by a skilled veterinary dentist who has worked with guinea pigs or a veterinarian who can read them well is important. What could turn up is elongation of the roots, a minor spur (that this vet missed), an abscess, or something else interfering with his ability to eat. It is good that he can still eat most things okay (still eating hay, right?). I think you are focusing on the gradual weight loss and his problems eating carrots (let me know if I missed something).

If separating them is hard on the pair, I would not do so long term. I do not recall Pinta or anyone else mentioning a CT scan as a primary diagnostic for malocclusion, which you are worried about right now.

I don't trust the claim the KMS alfalfa pellets and timothy pellets have the same amount of calcium. I would use the timothy pellets when you can get them if those are the ones you want.

I can say if they are still using the same labels Linda was using before she sold the business, it is complicated to make any changes to the labels themselves (you need the software to do it). I know this because I used to be the person who made the label changes for KMS Hayloft before it was sold when there was an error or change in the ingredients.

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AviN4
Supporter in '21

Post   » Fri Sep 03, 2021 10:47 pm


He is an exotics vet. Dr. Julian Rivera at The Center For Avian & Exotic Medicine:

https://avianandexoticvets.com/team

At what point is an x-ray worth doing, given the risks of general anesthesia? Maybe if the blood and stool test return nothing? Should I also wait and see if the weight loss continues? For how long? I'm not totally convinced that my interpretation of his carrot eating behavior is correct.

Or is it feasible to x-ray teeth without general anesthesia, and I should just find a vet who will do it?

Identifying a "a skilled veterinary dentist who has worked with guinea pigs or a veterinarian who can read them well is important" seems like a challenge. It seems especially hard to get appointments these days too. :( I have a generally good impression of my regular vet's knowledge about guinea pigs (Dr. Lawrence Buchholz at Animal Clinic & Hospital of Jersey City) so maybe I should schedule an appointment, even if it's a month out.

Midnight is still eating hay. And at least nibbling on vegetables and pellets. It's a little tricky for me to tell how much he's eating. I can try to watch him more often / more closely.

I'll avoid the alfalfa pellets.

Thanks for all your advice.

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Lynx
Celebrate!!!

Post   » Sat Sep 04, 2021 8:22 am


Did the vet suspect internal parasites for the weight loss? I ask because I don't recall many stool tests being done unless one is looking for particular parasites. And even then, some parasites can be hit or miss as far as finding them in the stool.
http://www.guinealynx.info/diarrhea.html

It sounds like you have decent vets and will be waiting for the results of the tests and moving from there, continuing to monitor weight and behavior.

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AviN4
Supporter in '21

Post   » Sun Sep 05, 2021 8:12 am


Yes, he suggested an internal parasite as a possible cause. I am skeptical given that:
- Moon seems fine.
- The gradual weight loss only began ~5 months ago, and it's not clear how they would have become infected unless it was from before I adopted them 3.5 years ago.
- I see no evidence of diarrhea.

But was non-invasive and relatively inexpensive so I agreed to proceed.

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AviN4
Supporter in '21

Post   » Wed Sep 08, 2021 8:35 pm


Both the blood test and the stool test were clean. Dr. Rivera asked me to bring Midnight back if I see 5% more loss in body weight, decreased fecal production, excessive salivation, seizures, etc. He said next steps could be teeth or abdominal imaging depending on symptoms.

Midnight is still exhibiting the unusual behavior with regard to carrots. Today I persuaded him to try eating a small carrot piece. But he took a few bites, mostly let it fall out of his mouth, and then lost interest.

To me all this seems like evidence of teeth problems. :(

I'm trying to get an appointment with my usual vet (Dr. Buchholz) next week. But it's possible I'll need to wait until Oct 4th.

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Lynx
Celebrate!!!

Post   » Wed Sep 08, 2021 8:43 pm


If you read the most recent topic in the med forum, you will note how complicated sorting out some of these issues can be! It looked like teeth issues but may instead be ovarian cysts interfering with eating enough food. At least your male would not have this condition.

I hope you do not see excessive salivation and certainly hope there are no seizures.

I wish all we needed to do was pop a couple nutritious treats into their diet to maintain weight. Hope you are able to see your usual vet sooner rather than later.

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AviN4
Supporter in '21

Post   » Wed Sep 08, 2021 9:01 pm


Thanks for your support.

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AviN4
Supporter in '21

Post   » Sat Sep 11, 2021 8:09 am


There are Midnight's test results from the visit last week. Dr. Rivera's interpretation was that these results are all fine. Glucose (147 mg/dL) to me looks on the high side, but probably not high enough to indicate diabetes or similar? Also, I suspect perhaps not reliable unless the test was done after a fasting period?

The reference ranges I've seen (such as the ones cited on GuineaLynx) indicate that 60-125 mg/dL is normal, but other sources (such as this old study) indicate that diabetic is more like >= 300 mg/dL.

I do have the impression that Midnight has been drinking more water, and my interpretation of that is was that eating less washed vegetables results in drinking more water. But I do see that both weight loss and excessive water drinking can be symptoms of diabetes.

I haven't noticed increased urination but it's hard to tell with their absorbent bedding.

Image

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Lynx
Celebrate!!!

Post   » Sat Sep 11, 2021 9:39 am


Would you like me to add your test result image permanently to your topic for future readers?

Unsure if reviewing how to tell if your guinea pig is dehydrated but since you are interested in water intake, I will add it here anyway. I note you say your guinea pig seems to be drinking more water so dehydration should not be an issue.

Dehydration: From what I understand, tenting of the skin at the back of the neck can be an indication of dehydration. A well-hydrated guinea pig, the skin would return to normal fairly quickly if gently pinched upward. A dehydrated guinea pig, the skin might be slow to return to normal. Teardrop shaped poops might also be a sign of not drinking enough (also an indication of not eating enough). Concentrated urine could mean your guinea pig is not getting enough fluids.

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AviN4
Supporter in '21

Post   » Sat Sep 11, 2021 7:11 pm


Sure, I would appreciate if you added the test result image permanently. Thank you!

It doesn't seem like dehydration is an issue but to be sure I'll do the skin test tomorrow when I weigh him.

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Lynx
Celebrate!!!

Post   » Sat Sep 11, 2021 10:32 pm


Thanks! I resized it slightly so it would load a little quicker.

It is good to have a baseline for comparison.

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AviN4
Supporter in '21

Post   » Mon Sep 13, 2021 6:30 pm


I took Midnight to my usual vet (Dr Buchholz) today. It seems like Midnight is showing signs of age.

He reported a cataract in Midnight's left eye, which he found by shining a light in the eye with the room lights off.

He also took a full body x-ray and found:
  • Likely arthritis in rear legs.
  • A bladder stone.
He did not find anything wrong with Midnight's teeth in either a physical examination or on the x-rays. The x-rays were not specifically dental x-rays though.

Among the issues, he said he thinks abnormal eating caused by pain from arthritis is the most likely cause of the weight loss. However, I'm still confused about the change in behavior with regard to eating carrots.

For arthritis pain, he prescribed Metacam (0.25 mL of 0.5 mg/mL) per day to start with and asked me to check back with him on Thursday. He said next steps would be to increase the dose. (On this topic, I found the dosing and administration to be confusing. I hope I got it right.)

I didn't have time to ask many questions or get many answers about the bladder stone as we had already spent a lot of time discussing other issues. I'll ask on Thursday.

I'll share the x-ray image when I get a copy.

User avatar
Lynx
Celebrate!!!

Post   » Mon Sep 13, 2021 9:06 pm


There are a number of member described case studies of arthritis. Unfortunately, there is not uniformity in describing amounts of medication (the dosage should be in mg/kg, which is the most useful) but other descriptions may help you if you are into researching it. Is he stiff when he walks?
viewtopic.php?t=34228

A recent topic, lots of potential issues, looked like teeth - and ultimately it was! Hay stuck in between the incisors, not visible, vet finally noticed it when food began rotting. This accounted for problems eating. Not yet known if all will resolve.

Sometimes diagnosing the cause of an illness can be quite complicated.

I'm sorry about the stone. Hoping it is small and can somehow be passed. Meanwhile, increasing fluids might help him pass it. I note he seems to be drinking more which perhaps could be adequate. Excess drinking can also be a sign of pain.

Guinea pigs can manage with cataracts. They can be associated with diabetes but not always. I am guessing age plays a large part.

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AviN4
Supporter in '21

Post   » Thu Sep 16, 2021 10:25 pm


Lynx, Thanks for the helpful reply. I'm still catching up, and have a whole bunch of reading to do on arthritis and bladder stones.

Midnight seems to walk fine, and frequently wanders around the cage. If he is experiencing pain while walking, he is not showing it. I've been giving him the Metacam anyway though.

I'm not sure if the bladder stone is small enough to pass. I'm including some x-rays below. Any idea what the prospects of a good outcome are without surgery? How seriously should I be considering preventative surgery? My vet is recommending against preventative surgery, and suggests euthanasia if the bladder stones reach his urethra and start causing him pain. His reasons:
  • It might remain asymptomatic and never reach his urethra. (How likely is this?)
  • My vet seems thinks Midnight is reaching the end of a life worth living. But I'm not so sure. He still seems like a happy little guy, and I'm not sure we've identified any confirmed issue that's destined to kill him or make him miserable.
  • My vet thinks with Midnight's pattern of weight loss and signs of age, the surgery could be risky.
  • The surgery would be expensive. My vet can't do it himself, but thinks it'll likely cost around $2,000 to $3,000 at the hospital he recommends (Red Bank Vet Hospital). Vet treatments in the NYC metro area are expensive. And if additional bladder stones continue to appear, this could become a bottomless money pit. I could shop around though, and maybe rent a car and drive to a lower cost area.
I'm not too concerned about the cataract. As long as he retains enough vision to find his way around his cage, I think he should be OK? And so far, it seems like it's just a mild cataract in one eye.

I'm attaching some x-rays of Midnight from a vet visit in 2021-04-24 and the recent one on 2021-09-13, as well as the nearest points on his weight chart. It looks to me like the arthritis was present at both visits, but the bladder stone was present only in the second one. But the weight loss only began a month or so after the first visit. This makes me wonder if the bladder stone is somehow the cause of the weight loss. Also, looking again at his weight charts, I'm wondering if something else happened during his accident on 2021-04-24 (box fell on him) that started this weight loss trend.

Lynx, feel free to permanently upload these images or use them however else you'd like.


2021-04-24 X-rays and weight chart

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2021-09-13 X-rays and weight chart

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Originals:
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2021-04-24 X-rays and weight chart

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2021-09-13 X-rays and weight chart

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User avatar
Lynx
Celebrate!!!

Post   » Fri Sep 17, 2021 9:30 am


I am wondering if there are stones in the ureter. I have a few topics I was going to review later but you might want to look at this, which includes a couple xrays and a photo the vet sent her from the necropsy, showing the string of stones in the ureter:

viewtopic.php?f=2&t=38332&hilit=ureter&start=100

The xray you include with the visible stone and a string of ? is not as detailed as the xray on that topic, showing the individual stones.
I think his initial sign of illness was rapid weight loss :-(

I will add your xrays later (thanks!).

What I plan to review (you might want to look them over):

Looked to me like a string in the ureter, still think this most likely but supposedly not:
viewtopic.php?p=2270350#p2270350

An xray on this post, similar to yours:
viewtopic.php?p=1735610#p1735610

Sef's xrays of Zachary:
viewtopic.php?p=1220928#p1220928

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AviN4
Supporter in '21

Post   » Fri Sep 17, 2021 1:43 pm


Thanks for sharing all that. I'm going to do my best to do a review this evening.

The front desk at The Center For Avian & Exotic Medicine in NYC said she can't give me any concrete numbers but that the surgical removal could cost $1,000 to $1,300, which is not nearly as bad as I thought. I think I'm willing to spend that if it makes medical sense.

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AviN4
Supporter in '21

Post   » Fri Sep 17, 2021 7:26 pm


Lynx, I just read through the links you share. Thanks, these were extremely helpful. Yes, Midnight's x-rays looks similar to the others diagnosed as having ureter stones, especially this one:

https://www.guinealynx.info/forums/viewtopic.php?p=1735610#p1735610

The weight loss pattern seems roughly consistent as well, though it's odd that Midnight has been losing weight more slowly than what I've seen described. The other symptoms seem less dire as well -- so far.

I see that if they are ureter stones, surgery will not be an option. All I could do is try to keep his weight up, make him as comfortable as possible, and bring him in to be euthanized when necessary.

Are there other tests that a vet can do to confirm where these stones are? It would help to know if I should still be considering surgery or if it's time to give up.

User avatar
Lynx
Celebrate!!!

Post   » Fri Sep 17, 2021 9:37 pm


I think a better xray might help. I had been looking at some anatomy pictures to try to visualize where everything is. All the sketches and pictures have the bladder being smaller. The two kidneys are under the spine. A thin tube (the ureter) attaches to the bladder, nearer the base of the bulb.

In some of the images I found, the individual small stones in the ureter are quite clear. Your xray does not quite have the clarity I would hope for to point out to your vet.

I have to take a neighbor to the airport early tomorrow (get up at 4:30) so I will come back to this topic later.

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AviN4
Supporter in '21

Post   » Fri Sep 17, 2021 9:56 pm


Hmm... do you think the x-ray needs to be redone or is it possible they just need to rescan it in higher quality? Or even easier, maybe just send me the original DICOM file? The images I received seem to be low resolution, low quality JPEGs. I'll email them to see if I can get something better.

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Lynx
Celebrate!!!

Post   » Sat Sep 18, 2021 9:35 am


Yes, that might help you evaluate whether or not it is worthwhile bring up the possibility of stones in the ureters. The DICOM file might still not be super big but hopefully would give more detail.

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