Emergency please help: Duck's URI gasping for breath

Post Reply
beefyduck

Post   » Sun May 14, 2023 6:38 pm


Thank you lynx for always responding to my posts and making me feel less alone. Ultimately the guilt of not doing everything I can for duck led me to keep my appointment.

Unfortunately we did not get good news. Her culture came back with klebsiella +3 (up from +1 at her orignal culture), which the vet let me know is extremely resistant to antibiotics and there's really only 2 medications we can treat with, both of which are injections and would also require subcutaneous fluids. She warned that these would be very difficult on ducks gut, and she expects thst we would need to go back to that intense syringe feeding regimen again.

The medications are amikacin and imipenem. I think it was the amikacin that risks kidney failure in older pigs. I haven't been able to do much research yet but this is very scary for me to think about. The baytril and azythromycin were so awful for her. I can't imagine putting her through something like that again. It is worth noting that she is currently doing well. She is eating, has good energy, and generally looks like she is enjoying life. The only remaining sign of the uri is the very occasional sneeze, which hasn't been getting worse in the last 3 weeks. I am hoping and praying that the infection doesn't get worse and that she can just live out the rest of her life unaffected by the klebsiella. Can someone please give me good news and tell me that there is a reality where she won't need these injectable antibiotics to get well. If I choose to spare her the antibiotics am I dooming her to eventually have a full blown uri where she is coughing and gasping for air again?

I did a quick search on the forums for threads about klebsiella infection and the prognosis was generally poor. Does anyone have experience with either of thes injectable medications? Please and thank you for the support

User avatar
Lynx
Celebrate!!!

Post   » Sun May 14, 2023 11:16 pm


I don't have any personal experience with this bacteria, that I know of. I'm going to add a few things I ran across on the internet.

Understanding the bacteria (which, I understand is everywhere - do you know what kind of klebsiella it is?) may be helpful:
https://en.wikipedia.org/wiki/Klebsiella

I did run across an entry over at the House Rabbit Society that says Amikacin can be used by injection (no oral form) but with caution as it is "nephrotoxic" (nephrotoxic: => poisonous to kidney tissue => toxic to the kidney)' That page claims a low incidence of diarrhea AND mentions that it can be used in nebulization protocols. I know no more than is on that page. But nebulizing, it might be less toxic to the liver and better address the respiratory aspect of what is going on. Your vet did not have the data when she turned down nebulizing earlier (if I am remembering right - I may be thinking of another poster).

http://houserabbitsociety.org/health/antibiotics.html

https://duckduckgo.com/?q=amikacin+nebu ... ntp&ia=web

Here is a human study of a resistant bacteria where 4 of 6 patients were successfully treated after other treatments failed.
"four of six people who had failed standard treatment for M. avium complex lung disease were culture negative after 6 months of inhaled amikacin without toxic side effects (14)."

If you search the word "toxicity" on this page, one of the comments made is, "The use of aerosolized amikacin has the potential for reduced toxicity. However, there is minimal literature pertaining to the efficacy of and side effects associated with inhaled amikacin. We evaluated the effectiveness and toxicity of inhaled amikacin in 20 patients with treatment-refractory nontuberculous mycobacterial lung disease."
https://www.atsjournals.org/doi/full/10 ... 1307-231OC

I admit to glancing over this last study and do not know if it is helpful but you may be able to find out more with your own searches.

beefyduck

Post   » Tue May 16, 2023 3:53 pm


Thank you for the links. It is promising that amikacin in nebulization protocols seems to be more effective than the injections. I am hoping it also is a bit easier on her gut. I was hoping to find a decent study on nephrotoxicity of amikacin when nebulized, but I didn't have much luck. I have made an appointment in 2 weeks for another exotic vet in my area. I'm hoping for a second opinion, as the current vet is insisting that injections are the only way to go. For now, Duck is off antibiotics and I am hoping and praying that the klebsiella doesn't give her any problems. After 5 weeks of antibiotics I am sure her gut will be happy without them. I am away for the next week and my mom is watching her for me but I am absolutely sick with worry and guilt about going away. Please send healing thoughts to Ducky.

By the way I got a copy of the culture results. If it is ok I would like to share with you for posting to this thread. Maybe someone on here has some insights to offer.

User avatar
Lynx
Celebrate!!!

Post   » Tue May 16, 2023 4:40 pm


Here they are! I cropped it and tried to make the file somewhat smaller.

Image

Very clear that the Amicacin is the drug of choice to treat Klebsiella pneumonia. It is also helpful that they point out the dangers of some of the resistant drug (many are on the dangerous list anyway). I don't know how one would compare the MIC values.

I don't know what the MIC readings mean. Maybe bpatters could clarify.

bpatters
And got the T-shirt

Post   » Tue May 16, 2023 9:04 pm


Minimum Inhibitory Concentration (MIC) is the lowest dose of a drug that prevents the growth of bacteria.

I'm assuming that they still do them the same way they used to, or at least something similar. A petri dish is a round flat dish, about an inch high. It's covered in a gel that has additives which feed bacteria -- different gels are used to test different bacteria. Once the gel is set, a wire loop is dipped in the bacterial solution and swiped across the surface of the gel to "infect" it.

The plates are then incubated until there is significant bacterial growth. Once that happens, small paper dots with specific concentrations of antibiotic are dropped on the plates. The antibiotic kills the bacteria in a radius around the paper dot. If no bacteria are killed around any paper dot, that antibiotic is ineffective against that bacteria at any dose. If the antibiotic is effective, the dots with the stronger dose of antibiotic will have a wider circle of no bacteria around it. The weakest dot with killed bacteria around it is the MIC.

User avatar
Lynx
Celebrate!!!

Post   » Tue May 16, 2023 9:10 pm


Thanks!

beefyduck

Post   » Fri May 26, 2023 5:08 pm


Duck has been steadily dropping weight every day for about a week now. The good news is she still has an appetite for critical care, vitamin c biscuits, and veggies. She won't drink water though and her pee is very brown. I suspect her molars are overgrown and it's causing her pain when eating.

Some more bad news:
-it looks like her sneezing fits have become a bit more frequent
-it looks like there is definitely something wrong with her left hip. A bone seems to pop out under her fur and gives her profile a very very strange look. I have absolutely no idea what this is. I just got back to town so I have no idea when in the last 2 weeks it started. I will email pictures over for posting

We have an appointment with a different vet tomorrow. I'm hoping to get a second opinion on the klebsiella and also hopefully get some good news with at least some of the other stuff she's got going on

User avatar
Lynx
Celebrate!!!

Post   » Fri May 26, 2023 8:26 pm


Here are your pics. I cannot tell much from them but perhaps one of our members has an opinion. Have you gently manipulated the area to see if that tells you anything? If there is pain, it can affect appetite and be partly responsible for weight loss. Let us know what the vet has to say about this.

Image

Image

Image

Have you thought of increasing fluids? Syringing water? Is Beefyduck getting any pain medication right now? (sorry if I missed that she is)

beefyduck

Post   » Fri May 26, 2023 9:19 pm


Thanks for posting Lynx. She has been on metacam daily for a few months now (due to teeth issues). We do try syringing water but she absolutely hates it so she doesn't get as much as we would like to give her. I'm thinking about mixing some pedialyte into the water and hopefully it will be more appetizing for her. Is there a specific product that is recommended for pigs?

I haven't tried manipulating her leg because I'm so scared of making it worse. But it is so turned out that I wonder if it popped out of the socket. I watched her put some weight on it and she looked really unstable on it and swayed before she put her right leg down. She's not showing obvious signs of pain. She still comes running up to you if you have food. Maybe it is the beginning stages of that calcium drop related paralysis that I've read about.

I will be sure to post again after our vet visit

User avatar
Lynx
Celebrate!!!

Post   » Fri May 26, 2023 9:51 pm


Is she still able to put weight on the leg and use it to move around?

I was thinking more of gently exploring the leg bones vs. manipulating the leg (because of the hair, it's hard to see what is going on but you may be able to feel it).

Good luck!

beefyduck

Post   » Sat May 27, 2023 6:55 pm


She does put weight on the leg but it looks very weak and always ends up with some sort of instability and she has to readjust. Earlier i saw her try to turn around and she put weight on the leg and it gave out and she fell over for a second. Other times when she puts weight on it she will just wobble until she readjusts and sits on it.

The vet felt around her hips and she said there is definitely a difference between her left and right leg. She has never seen a guinea pig with a dislocated hip but if there is a dislocation, it is not glaringly obvious. We can't rule out that it's not a dislocation without orthopedic xrays, but at Duck's age and with everything she's gone through recovering from her infection, the doctor doesn't feel very good about sedating her to get the scans. Additionally, if the scans did confirm a dislocation there's not much we would be able to do for her anyways since orthopedic surgery is nothing to scoff at for a 6 year old pig. She also mentioned that it could be arthritic changes. On this front we are just going to continue giving her metacam daily. I also have a cbd gel that will hopefully give her some more relief.

Regarding the klebsiella, I asked if it's possible at all that Duck can live with klebsiella present without experiencing any sort of illness from it. She said its not a normal bacteria for guinea pig flora, but it is possible. Klebsiella is an opportunistic bacteria and it is possible that as long as her immune system is working well she can keep the klebsiella from taking hold making her sick. I hope this information is helpful for someone in the future.

The vet did give me some peace of mind today by saying that if duck has an appetite and energy then I can consider the day a win. She didn't offer any sort of diagnostic tests or prescriptions, so I think my job now is to keep Duck happy and comfortable as long as possible. I've also got some generic brand pedialyte to hopefully boost her hydration and help her kidneys out.

beefyduck

Post   » Sat May 27, 2023 8:35 pm


By the way, the pedialyte I got her is mixed fruit flavor. Can anyone confirm if this is ok before I give it to her? The ingredients say less than 2% of natural and artificial flavors. Thanks a lot!

Post Reply