Elise's diarrhea thread

alex117

Post   » Sat Aug 28, 2021 1:42 pm


Hi all the cavy lover,

My Elise is a 5 years old female guinea pig with history of chronic heart failure (we got her out of critical stage 2 weeks ago). She is taking furosemide (.06ml 3 times a day), Benazepril (.1ml once a day) and pimobendan (.05 2 times a day). On top of that, she had a low grade fever (104F) on last Friday, and the vet prescribed her with doxycycline and baytril.

She had this combination of antibiotics for 6 days, and there is no change on her appetite and her poop was actually become more healthier. However, the day before yesterday, i have given her 130g of veggie within a 20 hours interval (which is doubled then what she had for the past two weeks). And the clinantro that i fed at night may be rotten (it looks fine to me but i saw there is a lot of leftovers when i fed the same bunch to my 4 other guinea pigs.

And nightmare started to happen, on yesterday morning, i notice a decrease of her poop volume but i wasnt paying a lot of attention to it, so i give her 22g of lettuce and 6g of baby carrot. At 6pm yesterday, i started to see soft poop and i immediately stopped all veggie for her. And at 10pm, her poop become very soft and mushy (it was like a poop that can break down to 3 to 4 health poop, but it came out as 1 connected soft and mushy lengthy poop). I paused 1 dose of Baytril last night, gave her 1 extra dose of ben-bec probiotics and reduced furosemide from 3 dose to 2 dose a day. I started critical care feeding this midnight as i see she dropped almost 32g within a day (776g to 744g).

However, it has been more than 12 hours now, but i am still seeing the poop remain soft and mushy. In terms of her behavior, she still eating hay, drinking water, begging for veggie, remain relatively active and show no sign of labor breathing.

Given her heart condition, i hesitate to give her extra water to hydrate her as i may just give her pulmonary edema again. So i dont know what to do next.

Is this an emergency? Any advice?

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Lynx
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Post   » Sat Aug 28, 2021 11:18 pm


I am sorry she is so ill. Have you had a way to monitor her temperature? I was going to say a temp of 104 is fairly high but checking the norms page, I see two sources list normal temperature as 99.0 - 103.1 -- 104 would instead be high for a human.
http://www.guinealynx.info/norms.html

I think visually you would bee able to tell if the cilantro was bad. It may instead be bitter and not palatable to your other guinea pigs. I am guessing the antibiotics are the more likely cause of the strange poops. Unfortunately, I cannot make the call that this is an emergency - I do not have a veterinary background and can only say this is a choice you would make. You seem knowledgeable yourself and are trying to do your best.

If the poop becomes watery, I would consider that an emergency - or if you see a change in the behavior you are describing, I would also want to counteract dehydration if the poop becomes more watery.

You are really best placed to make this call. It sounds like you care for her a great deal. I wish it wasn't a weekend and you could consult with your vet.

alex117

Post   » Sun Aug 29, 2021 12:25 am


Thanks for your reply.
She had accurate pulmonary edema 12 days ago and she got her temperature measured 7 days ago. Back then she shows no sign of other clinical symptoms except the effort of her breathing is still heavier than the baseline. So maybe there is some sort of bacteria get into her lung back then.

After taking baytril and doxycycline for 3 days, her effort of breathing is back to normal, appetite increase and her poop become more and more healthier. So i dont think temperature is a good indicator to reflect her current health, also i guess if antibotic is the root cause then her poop won't show any improvement during the course of the antibotic.

Also quick update on her, she is still very active and beg for food all the time. And her poop is still clumpy but i think the poop is getting a bit harder. Her weight also getting a bit heavier.

However, when i was wrapping her anus i saw blood, i think it may caused by me (kitchen paper maybe too sensitive to her skin). And thats the only time i saw blood so far.

alex117

Post   » Sun Aug 29, 2021 7:29 pm


Phew, after 36 hours, Elise's poop is finally back to "normal", her poop is still soft but it is well-formed.

Not sure what caused her diarrhea still but at least we are seeing some major improvement now :)

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Lynx
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Post   » Sun Aug 29, 2021 9:31 pm


At least you will have a week available where you could talk to a vet if you needed to. Weekends can be difficult if your guinea pig is sick.

The labored breathing can also be due to fluid in the lungs - but if the antibiotics are helping, bacterial, as you suggest instead.

alex117

Post   » Wed Sep 01, 2021 3:47 am


Agree. Elise diarrhea is completely gone today yay.

However, i feel like she is breathing harder than baseline (not faster but the amplitude of each breathing is larger). I have given her more furosemide today. She is getting doxycycline and baytril for a week, i think it is because of the fluid in her lung again.

By the way, for pig that has enlarged heart, should we give watery veggie to them? Currently, i dry the lettuce with a paper towel before serving to her, i know if a human has congestive heart failure, doctor will issue fluid restriction, but i am not sure if this is the same case with guinea pig.

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Lynx
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Post   » Wed Sep 01, 2021 8:23 am


I don't have a veterinary background but do know the furosemide can be adjusted (as you did). If you are concerned, you could also just rinse the lettuce and give it a good shake to remove the excess water. This would be a compromise.

I do think Elise is in the best of hands. You are very observant and fighting for her.

alex117

Post   » Wed Sep 01, 2021 9:45 pm


Quick update on Elise situation. Her breathing kept getting heavier, i have switched to furosemide injection and giving her 4mg Furosemide per dose. Lets hope she can make it.

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Lynx
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Post   » Wed Sep 01, 2021 10:14 pm


Sending good wishes your way!

alex117

Post   » Thu Sep 02, 2021 6:35 am


Unfortunately, Elisee has passed away.

At today 4pm, i saw her breathing become heavier and from stethoscope i hear cracking noise from every exhale. I immediately increase furosemide intake to 4mg q4 and switched to injection for quicker effect. I got the cracking noise out at 6pm, however her breathing remain heavy. And my area only has one 24/7 exotic animal center and the doctor is available after 10:30pm. By that time her appetite has decreased by a lot, so i switched to critical care and just to get something into her GI.
We got into hospital at 10:35 pm and we immediately put her in o2 tank with an extra shot of furosemide. Later that time, we took an x-ray to see what is going on, it turns out she had pleural effusion. We waited an hour but we dont see a huge improvement on furosemide, so the vet use ultrasound and put a needle in her chest to draw out the fluid. What she got is fluid mixed with blood and she passed away during the operation.
From the ultrasound, it appears that her heart also has a mass (maybe a tumor) and the valve cant close completely (which means pimobendan isnt able to fix it as well).

The vet also said i have done everything i could and went way beyond as an owner. She also said even we end up fixed her this time, her situation is not manageable in long term.

The vet is not examinating elisee's body. I will keep you all later.

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Lynx
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Post   » Thu Sep 02, 2021 9:01 am


Oh, alex117, I am so sad to hear Elisee is gone. The vet could not have spoken truer words when she said you had done all you could have done. That she was able to give you insight into what was going on with Elisee I trust was helpful to you, the same as having a necropsy would have been.

You have all our sympathy. I know how much you loved her.

bpatters
And got the T-shirt

Post   » Thu Sep 02, 2021 9:26 am


I'm very sorry you lost her.

alex117

Post   » Thu Sep 02, 2021 3:05 pm


Hi everyone,
The post mortem result has just come back. Below are the results of the post-mortem examination for when you are ready.

On Elisee's post mortem exam, there were several abnormalities. The final diagnosis looks like cancer.

First and most obvious, there was a lot of blood in her chest. I think all the fluid I saw on radiographs was blood, some of which might have clotted prior to death (it would account for the "tissue" I saw with ultrasound). There was a lot of blood in the pericardial sac around the heart, which was likely the immediate cause of her death (ie, pericardial tamponade)

There was a solid white mass inside her heart; it was large, and took up nearly the entire left atrium. I looked at the cells under the microscope, and it looks like a sarcoma (soft tissue tumor, where the cells have a characteristic "spindle-shaped" appearance). This would explain the changes in her heart, as her heart would have been working overtime to make up for the space the mass took up, and over time will lead to heart failure. The mass may have recently grown large enough to partially obstruct the valves in and/or out of the atrium, and was easily large enough to push on other chambers & blood vessels of the heart. The aorta & pulmonic vessels are right in that area. I did not see a direct source of bleeding, but if there was a small tear in the heart or one of those blood vessels, it would absolutely account for the blood in her chest, and can take time to accumulate.

There were several white nodules in her lungs (also sarcoma-looking cells).

Her liver was small & irregular, and there were several white nodules there, too (also sarcoma-looking cells). Liver dysfunction can cause clotting disorders, but it looked like there was still some functional tissue.

The mass in her neck was mostly filled with fluid; some of it was dark-brown, some looked like old unclotted blood. The outer shell was thin & mineralized. This looks like some kind of cyst.

Overall, this looks like cancer. I think the mass in her heart is what led to her heart failure. Hemangiosarcoma (tumor of the blood vessels) usually affects these tissues and usually presents with bleeding, but those tumors typically dark red, not white.

Full Necropsy Report

External exam
--Integument: lice on left (up) side.
--BCS: 2/5

Internal Exam
--Thorax: Large amount unclotted bloody fluid left (up) side of thorax, large amount clotted blood right (down) side. Great vessels appear intact, no lacerations or punctures.
--Cardiovascular: Large amount unclotted blood in pericardial sac, potential pericardial tamponade. Heart large, right ventricular wall thin. Large (~5mm) round firm tan pedunculated mass arising from dorsal inner wall of left atrium/auricle, took up majority of space inside atrium. Cytology: Spindle cells, mild anisocytosis, mild anisokaryosis, ~1 binucleate cell per 3 hpf
--Respiratory: Lungs very small/compressed. Many small black specks throughout parenchyma, 2 small black dots ~2 mm each. 3 round white spherical nodules visible on lung surface; cytology shows combination of homogenous vacuolated epithelial cells & spindle cells.
--Abdominal cavity: wnl
--GI (stomach, intestines, cecum etc.):
--Pancreas: WNL
--Liver: Small, irregular, mottled, pale. Several large (~5mm) white nodules present (tip of right lobe, another near gallbladder). Several small black miliary nodules visible.
--Spleen: WNL
--Urogenital: WNL.
--Nervous system: WNL.
--Musculoskeletal system: WNL
--Mass left ventral neck: ~1.5 cm hard + fluctuant mass. Cranial aspect mineralized, medial pocket of mass filled with translucent black brown fluid, dorsolateral pocket filled with dark nearly black unclotted blood.

Differential diagnosis: Metastatic neoplasia; cytology suspicious for sarcoma. Clinical signs & locations of masses consistent with hemangiosarcoma, but masses look white not red.
Hemothorax: source of bleeding may have been lung mass, left atrial mass, liver failure/coagulopathy. Death may have been cardiac tamponade or blood loss.

Samples saved for histopathology:
heart & lungs, piece of liver, neck mass

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Lynx
Celebrate!!!

Post   » Thu Sep 02, 2021 9:56 pm


Thank you for taking the time to write this all out and share it with us. It looks like a very detailed examination. It is often so helpful to know the full extent of the medical issues your pet was dealing with. It does sound like there was no way forward that would have saved her.

If you follow through with the histopathology of the samples the vet has collected, let us know what is found, especially if there is confirmation of sarcoma.

A good vet when doing a necropsy generally has an idea of what he/she is looking for and after a gross necropsy, will send specific samples to be examined. This provides a more complete picture of what happened.

I know your loss still hurts.

alex117

Post   » Thu Sep 02, 2021 11:47 pm


Thanks Lynx! Life must move on, I feel like it is also my responsibility to remember this moment and write down everything I could so that other owner can reference this thread in the future.

I am thinking about the need for histopathology, please correct my thought process if I am wrong (i am more than happy to order it if it helps).

The Necropsy report indicates couple of things; 1) Clinical signs & locations of masses consistent with hemangiosarcoma, but masses look white not red, 2) the white mass cells under the microscope looks like sarcoma (Cytology: Spindle cells, mild anisocytosis, mild anisokaryosis, ~1 binucleate cell per 3 hpf). 3) white spherical nodules were seen in Lung, Heart, and liver, so we can also confirm there is Metastatic neoplasia.

Based on that, we are almost sure she has cancer, but we don't know what kind of cell it is (it is likely to be sarcoma). With a further investigation on the histopathology, what we can find out is the specific cell of this cancer, with enough research, we probably can extract the marker of it. I think if Elisee is a human, it may be worth knowing this because it helps the doctor to develop a specific chemotherapy treatment to kill this type of cancer. However, Elisee is a little bean, and just like other guinea pigs, I am not sure chemotherapy treatment is something that their system can tolerate (they may but it is only one single case https://cvm.ncsu.edu/courageous-guinea-pig-fights-cancer/). And also, if it is a hemangiosarcoma, even we have a solution to kill the cell, there is no way we can take a biopsy that can confirm it is a sarcoma (well, no way we can biopsy the heart). So I am not sure how useful it can be for other cute piggies.

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Lynx
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Post   » Fri Sep 03, 2021 8:37 am


I do not know enough to say if the biopsy would be useful to other guinea pigs either. In a typical case study, the problem is identified and treatment is given, generally successful to show the way for others whose guinea pigs with similar issues. Unfortunately for you, the extent of the medical issues was only discovered during a necropsy.

Whatever you choose to do, thank you for sharing Elisee's medical information.

p.s. the linked to article discusses surgery to remove a skin cancer of the cheek. The first surgery did not completely remove the margins and a second surgery was required. In my limited experience, it seems skin cancers, if they have not metastasized, can be removed. Your guinea pig's issues were much more extensive. I recall one guinea pig here, Big Boy, who had cancer treatment some years back.

alex117

Post   » Fri Sep 03, 2021 11:36 am



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Lynx
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Post   » Fri Sep 03, 2021 8:09 pm


That is a sweet story. I hope she had a good outcome from the chemotherapy.

alex117

Post   » Sat Sep 04, 2021 3:04 am


I think i will do histopathology on her heart tissue, i will keep you posted :)

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Lynx
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Post   » Sat Sep 04, 2021 8:16 am


I found a link to the lymphoma case I wanted to mention, though it still is not the same as what your guinea pig had. More similar to the link you gave.
http://www.guinealynx.info/records/viewtopic.php?f=23&t=123&p=237

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