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 Post subject: Non specific symptoms in 18 month old rat
 Post Posted: Thu Aug 17, 2017 9:24 pm 
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Location: Gothenburg, Sweden
Paws is a lovely 18 month old female rat who is usually healthy and active. Over the last few weeks we have noticed on occasions she has been a bit 'quiet', just not her usual self. This seems to have become more pronounced over the last few days.

She is less keen to come out of the cage and seems slow on her feet (no limp or specific weakness that we can tell). She tends to be spending more time at the bottom of the cage and struggling a bit to climb. Today she fell off a low shelf in the cage. I saw it happen and it was like a lack of balance and/or coordination. Her weight is stable and she seems to be eating and drinking (hard to tell amounts with 5 cagemates around and mostly scatter fed).

She also nipped me a couple of times the other day which is very out of character for her.

We are wondering if it is something neurological? I haven't taken her to the vet yet but wondering if I should?

Any thoughts and advice will be gratefully received.
Thanks,
Helen

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Popcorn, Me-Me and Nelle
Never to be forgotten: Trixie, Paws, Tica, Doris and Bella ❤️


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Thu Aug 17, 2017 9:34 pm 
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Definitely time for a vet visit. Nipping suggests she's not feeling well about something. The balance and coordination problems do sound like something neurological to me, though I'm not an expert. If it's just balance with a head tilt then I'd suspect ear infection; if coordination is involved, particularly poor control of the forelegs, then I'd suspect more something neurological, possibly a pituitary tumour. :(

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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Fri Aug 18, 2017 6:37 am 
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Ditto what cub says. If it is a pt then hopefully a steroid injection will help. It's not a cure but will ease symptoms. Some people also have used galastop but I have never used it.

:luck:

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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Fri Aug 18, 2017 10:41 am 
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Caza66 wrote:
If it is a pt then hopefully a steroid injection will help. It's not a cure but will ease symptoms. Some people also have used galastop but I have never used it.


Agreed on the steroids if anything neurological is suspected, not just PTs, since they also help with strokes.

ETA: A steroid injection is also not a bad idea if it's an ear infection, as it can bring down the inflammation while the antibiotics kick in.

If a PT specifically is suspected then I'd recommend cabergoline tablets, not Galastop (which is a brand of cabergoline as a liquid suspension). The dose of cabergoline currently recommended for PTs is so high that getting it into them using Galastop is difficult, since Galastop is not very concentrated. Easier and probably cheaper to get human-formulated cabergoline tablets, crush them down, and dose them out. (It's 600μg/kg per 72h in the BSAVA formulary 9th ed, which works out as 200μg/kg per day, which would be 2mL of Galastop for a 500g rat which is quite a lot to get into them.)

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Poo-shoveller to: Zephyr Delanynder, Lia, and Lita.
Fondly remembering: Falere the contrary NLA36, Mirala the best and finest NLA36, Zephyr Opold the serene, and Rila the rodentist.
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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Fri Aug 18, 2017 5:25 pm 
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[cub] wrote:

If a PT specifically is suspected then I'd recommend cabergoline tablets, not Galastop (which is a brand of cabergoline as a liquid suspension). The dose of cabergoline currently recommended for PTs is so high that getting it into them using Galastop is difficult, since Galastop is not very concentrated. Easier and probably cheaper to get human-formulated cabergoline tablets, crush them down, and dose them out. (It's 600μg/kg per 72h in the BSAVA formulary 9th ed, which works out as 200μg/kg per day, which would be 2mL of Galastop for a 500g rat which is quite a lot to get into them.)


Good to know.

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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Sat Aug 19, 2017 4:49 pm 
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Location: Gothenburg, Sweden
Update:

Thanks for the replies everyone. I took Paws to the vet yesterday (a good knowledgable rat friendly one) who examined her really thoroughly. The main thing she found was that Paws was quite wobbly and had upper respiratory noises. She had 2 thoughts about diagnosis. The first, and most likely, she said was an ear infection (despite a lack of head tilt). The second is a pituitary tumour. She prescribed metacam (anti-inflammatory) and vibanord (antibiotic) to treat an infection and we are keeping our fingers crossed that this improves matters.

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Popcorn, Me-Me and Nelle
Never to be forgotten: Trixie, Paws, Tica, Doris and Bella ❤️


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Sun Aug 20, 2017 5:29 pm 
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Hi Helen,
I would ditto everything Cub and Cazza have said. Brain tumours (not just PT) tend to creep on. A stroke would be more sudden. Inner ear is possible but I think if its been apparent over a few weeks then it would be more advanced by now (I may be wrong however).
Sadly Ive dealt with several brain tumours and all have started as "not himself" or "looking a bit off" etc.
I would keep a vigilant check for other neurological symptoms here, signs such as:
Leaning to one side, turning, circling,
Absent mindedness and moving around without any real intended direction,
Loss of sensitivity to touch around face, whiskers, ears,
Bulging of one eye compared to the other,
Hands and forelimb weakness - hold her in your hand and run her legs up against the side of a table, she should step her feet up onto it. Not stepping one side or both would be a neuro symptom.
Leaning to eat - ie holding with one hand and leaning on the other (possibly the weaker/unsensitive one).

The Rat Guide Health pages have good info as a reference point : http://ratguide.com/health/neoplasia/pituitary_tumor.php
The symptoms for PT or any other brain tumour are somewhat vague and by no means always present, so a general view of symptoms and how they might relate is perhaps the best early stage assessment.

For an Inner Ear infection, Ive only dealt with it once, and he was quite advanced when I got him, but head tilt and tumbling were very pronounced - he really couldn't tell which way was up and would literally corkscrew in my hand - ABs cleared that up quite quickly.
Hopefully you'll see an improvement with the ABs and Metacam, but keep a close eye for other symptoms on a day by day basis and monitor her weight. Its not uncommon for infection to come in alongside of a brain tumour due to the effects it has on the body function so certainly the ABs are needed for the resp issue.

Scritches to Paws :)

_________________
Doug, witless provider to :
Ratties :smile: 2x yet-to-be-named ex lab boys :girly: Jess.
Budgies Freyja and Haiku.
:rattyrainbow: 42 storytellers loved and lost, most recently : Washburn :rattyrainbow:


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Wed Aug 23, 2017 7:46 am 
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Location: Gothenburg, Sweden
Another update:

Paws has now been taking the metacam and vibranord for 5 days. She is perhaps a little brighter in herself but there has been no massive improvement.

We have been feeding her soft food which she is loving (and taking plenty at speed!) although she is very messy with it. Her weight is stable at the moment.

Referring to the great advice and information above, I have been watching her quite a lot and am wondering if her vision is not very good. She also seems to wander around with no real purpose. She is much more squeaky than she used to be and her fur is looking old and appears to be thinning. We have also found her sleeping in places she never used to - on the substrate in the base of the cage and on a shelf for example.

So, my gut feeling is that we are dealing with a PT :( .
From the info you people have kindly shared, I think we should start her on some steroids and possibly some cabergoline. But we live in Sweden so I don't know what the 'usual' treatment for a PT will be. I hope they will listen to my requests....

Thanks for all the helpful advice.
Helen

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Popcorn, Me-Me and Nelle
Never to be forgotten: Trixie, Paws, Tica, Doris and Bella ❤️


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Wed Aug 23, 2017 9:52 pm 
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Poor girl. :( If you plan on switching her to steroids, stop the Metacam, as NSAIDs and steroids can't be given together. Vets here like to have a 24h gap between the two classes of drug. A steroid injection at the vets is a good way to start, as I believe it's supposed to be more effective than oral steroids. Oral steroids are more convenient though so you can continue treatment at home with steroid tablets. Cabergoline is only useful if it's a PT specifically so if the vet won't give it then at least get some steroids to see if they'll help.

Give her a scritch and some delicious food for me. :hearts:

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Poo-shoveller to: Zephyr Delanynder, Lia, and Lita.
Fondly remembering: Falere the contrary NLA36, Mirala the best and finest NLA36, Zephyr Opold the serene, and Rila the rodentist.
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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Thu Aug 24, 2017 9:40 am 
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Poor girly, being a keen eater is good though, shes still enjoying her food :)
Agreed, if you plan to switch to steroids, stop the metacam 24hrs before you see the vet so they can give her a Dexamethasone shot while youre there.
As Cub says, the shot is more effective and acts more quickly. Normally I would get a steroid shot first (24hr dose) just to jump start the process, then continue on tablets (prednisolone) which you can split with a scalpel blade and crush between two tea spoons and mix into a small amount of something nice. With steroids you should see an improvement quite quickly, within 24-48 hrs.

I would keep her on the antibiotics for now too.

If she happens to pee while shes at the vet then get them to do a test strip to check for anything going on with kidneys etc. Id lso have them palpate the abdomen for signs of anything enlarged, just because of the non-specific nature of it all.

I hope she can be more comfortable on the steroids, at the very least they do tend to make them feel good and keeps the appetite up.

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Doug, witless provider to :
Ratties :smile: 2x yet-to-be-named ex lab boys :girly: Jess.
Budgies Freyja and Haiku.
:rattyrainbow: 42 storytellers loved and lost, most recently : Washburn :rattyrainbow:


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Thu Aug 24, 2017 9:53 am 
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Update:

I rang the vet yesterday to tell her about my concerns. She agreed it sounded like a PT. I asked about giving Paws a steroid injection and she said they don't do that in Sweden (increased risk of infection or something and Paws has been treated for mycoplasma in the past). :(

However, she did say she would ask her colleagues and look at the latest recommendations for treatment. She will get back to me by Monday..... That's 5 days from the conversation. I am so upset and don't want to have to fight for this..... :cry: :cry: :cry:

What should I do?

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Popcorn, Me-Me and Nelle
Never to be forgotten: Trixie, Paws, Tica, Doris and Bella ❤️


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Thu Aug 24, 2017 3:56 pm 
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Steroids do suppress the immune system (among many other effects), but I don't think that necessarily precludes their use in this case. I mean, if it did, nobody would ever use them as anything other than immunosuppressants, and that's clearly not the case. Here in the UK at least, they are sometimes used alongside antibiotics to treat rats with ear infections and severe respiratory infections, since their anti-inflammatory property can be very helpful in managing symptoms, allowing the patient to have less earache and/or less difficulty breathing, both of which are good things. If they just completely killed immune systems dead then they wouldn't be quite so helpful. :P

If you're reasonably sure it's a brain tumour then realistically you're only looking at palliative care. :( Everyone has their own view on what is and isn't appropriate in a palliative setting, but my personal view is that quality of life is more important than length of life. If you share that view, let your vet know; I've found that vets can be reluctant to prescribe treatments that shorten a terminally ill pet's life, but once I make it clear that I'd rather they die sooner but in comfort rather than live longer but in more discomfort, the vet becomes more willing. If the concern is a mycoplasma flareup, she's on Vibranord (doxycycline) which works against mycoplasma anyway. Steroids as palliative tumour treatment is quite standard in the UK as far as I can tell.

The only thing that would make me hesitate to go for steroids in your case is if there's any reasonable chance it's something other than a brain tumour. HereticPr1me's suggestion to do a urine test is a good one, if you haven't already. If you can get your hands on some urine test strips (everyone just uses the ones for humans) you can have a go at home. Or syringe up a urine sample and bring it to the vet, although usually you need to get it there the same day (keep it in the fridge if your appointment isn't within the hour). To get a clean sample you'll need to pop her into a clean, bare carrier and wait for her to pee. Getting them just out of bed is generally a good time, since they'll often need a pee then, but your mileage may vary. (Mine seem to have bladders of steel when they want to...)

Good luck. :luck:

_________________
Poo-shoveller to: Zephyr Delanynder, Lia, and Lita.
Fondly remembering: Falere the contrary NLA36, Mirala the best and finest NLA36, Zephyr Opold the serene, and Rila the rodentist.
Avatar by Ursula Vernon.


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Fri Aug 25, 2017 1:26 pm 
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Yep, and I would also add that the steroid should have an effect within 24hrs or so, and I would put it to the vet that if there is fair suspicion of a PT then it is worth using it diagnostically for that reason. And if it helps, then continue for all the reasons Cub has described.
Having the broad spectrum antibiotic "overhead" can help keep the infection under control in the meantime. The body's immune system still has to work, but its a balancing act in the end of the day, and if there is a PT involvement then both need to be tackled simultaneously.
Its good that theyre willing to ask around though, that's a good sign, I like vets that are willing to do that.
If they still do not approve, then my approach would be to say something like "I understand everything weve discussed and your concerns about using them, but Im asking to try the steroids and see if we can get a response, because then we will know where we stand and can take it forward from there"

EDT: If they wish they could contact the exotic specialist at Highcroft Referals here in the UK http://www.highcroftvetreferrals.co.uk/vets/advice-service <<- link to their advice service for Vets.
They should ask to speak to Elizabetta, shes my referrals vet who recently dealt with my girl Zoe in a very similar situation.

_________________
Doug, witless provider to :
Ratties :smile: 2x yet-to-be-named ex lab boys :girly: Jess.
Budgies Freyja and Haiku.
:rattyrainbow: 42 storytellers loved and lost, most recently : Washburn :rattyrainbow:


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Fri Aug 25, 2017 7:20 pm 
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Location: Gothenburg, Sweden
Hello again.

So, I have managed to get my hands on some 2.5mg prednisolone tablets thanks to a doctor friend. I have also had some excellent advice from a UK vet who also happens to keep rats (another friend).

I have not heard from my vet since I spoke to her on Wednesday.


Paws is much the same. Thankfully still loving her soft food diet! Who knew a mixture of ready brek, coconut, and chicken & rice baby food could be sooooo delicious :lol: . She had a dose of metacam this morning but will have no more.

Although Paws won't get an injection of steroids, I am keen to start her on the prednisolone tomorrow morning. I feel there is really not much to lose at this stage. We still have a little vibranord left and will continue that. I feel a bit guilty about doing my own thing but Paws is our pet, and I feel I have had lots of good advice from this forum, my other reading and my vet friend. I am a doctor by training and have some idea of pros and cons of such treatment.

So, does starting the pred in the morning sound reasonable? Paws weighs 300g and the advice I have recommends 1mg once a day for 5 days then slowly decreasing the dose over time to a maintenance dose of 0.5mg every other day or even every 3 days.

Thanks for reading!

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Popcorn, Me-Me and Nelle
Never to be forgotten: Trixie, Paws, Tica, Doris and Bella ❤️


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 Post subject: Re: Non specific symptoms in 18 month old rat
 Post Posted: Fri Aug 25, 2017 8:35 pm 
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I think your proposed course of action is entirely reasonable. The BSAVA formulary dosage for prednisolone for rats is 1.25-2.5mg/kg per day, so for a 300g rat the top dose would be 0.75g. 1g is higher than that but not by that much, so I suspect that would be fine in a palliative context. Alternatively, if it's more convenient you can split a 2.5mg tablet into thirds for a .83g dose.

Give Paws a scritch for me, bless her.

_________________
Poo-shoveller to: Zephyr Delanynder, Lia, and Lita.
Fondly remembering: Falere the contrary NLA36, Mirala the best and finest NLA36, Zephyr Opold the serene, and Rila the rodentist.
Avatar by Ursula Vernon.


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