Charlie has to go to Critical Care Unit :(

[ldjohan]

I took Charlie, my chin, to the vet today. I noticed that he hasn't poop or eat since two days ago. He drank only a bit of water. He's not as active as usual, but he still played on his wheel until this morning. I was so worried.

The vet took some x-ray, and found a big blob (looks like a balloon) of gas built up in his belly and the size of his intestine is much larger than normal size.
He sent me to the Emergency Care in Angels Memorial in Boston; He said they have board certified exotic small mammal specialist, radiologist, better equipment, and have 24 hour staff who can give treatment and monitor Charlie.
I took him there right away, and they said that most likely Charlie has obstruction in his intestine. They suggested 2 options to me:

1. Surgery to remove the obstruction, but they said Charlie only has 50% chance of surviving the surgery. And they might not find any foreign objects or anything during the surgery since it could be caused by tumor or the nerve system is just not working which cause the intestine to enlarge.
Given Charlie's age (about 3 yrs old), they don't think it's tumor, but it's still a possibility. Radiologist didn't recommend ultrasound since if I'm going to do surgery, why wasting the money to do ultrasound which will result in surgery anyway.

2. Supportive Care which is letting Charlie to stay at the Critical Care Unit for 1 or 2 night. They'll give him IV, medications, critical care food which will result in having his digestive system to do some work and hopefully he'll be able to pass whatever that blocking his intestine.

They did advise me that both options is extremely risky. I ended up choosing the Supportive care (not going through the surgery route). I'm not sure if I want to make him going through surgery with only 50% chance of surviving the surgery, not to mention complications/side effects after the surgery.

I'm hoping I made the right decision. He's in the hospital tonight, and I hope to get a phone call with good news tomorrow.

I have been careful so far with him. I've never let him run around the house without any supervision. Most of the time he'll play inside his playpen. Once in a while he'd jump out from my hand while I was holding him, and he was able to run around for a couple minutes since I could not catch him back until I offered him his dust bath. There's nothing in his cage that's dangerous for him. I did use Aspen bedding which I'm hoping isn't the caused of the obstruction. I'm not sure what caused the obstruction? Hairballs?

Any thoughts on the treatment or cause of obstruction will be greatly appreciated.

 

[ticklechin]

The chance of survival for that type of surgery is less, more like 10% and if the chin lives through it there is no guarantee the gut won't die. Chins do get intestinal tumors, a ultrasound IMO is a good idea since it can show if the item is anchored to the intestinal wall or not as opposed to a x-ray. Obstructions can be caused by what the chin has eaten that is not food or they can be caused by the gut slowing down allowing the obstruction to become dehydrated and hard, it could be a tumor. I had a father and son chins who both got tumors around 4 years old so I have experience with this issue, both had chronic issues with the gut up to the point of diagnosis.

 

[smhluvsmh]

Sending healing thoughts!

 

[ldjohan]

I just got an update from the doctor. Not a good news .
He's still not improving as far as his intestinal size, but he's still hang in there and his condition is still the same as yesterday. Not as dehydrated since they've been giving him sub-q fluid.
The doctor still suggests going through surgery; I'm leaning toward taking him home and forcefeed him, giving him fluid, massage, and warm compress.
I called a few other vets for second opinion, and waiting to hear back.

Maybe I'll ask for the ultrasound to see if it's tumor or not. Having to pay thousands of dollars with chance of survival of 10% is so hard to justify, and I'm not sure if I want Charlie to go through that.

 

[ldjohan]

One question for Dawn, if the ultrasound shows the item is anchored to the intestinal wall, is that mean surgery is the only option? There's no way for the object to be passed by itself?

I can't think of anything that he ate or chew that could cause this since his cage is all chew proof (no plastics), and I've never put anything in his playpen that's not chincilla prove.

 

[AZChins]

I don't know if you'd want to try the surgery at all. Chins have a very thin wall to their intestines, it's almost impossible for a vet to suture them back together once cut. 10% would be optimistic for the survival rate with this type of surgery.

I hope that you can get the gas to go down and get this little guy producing some droppings soon. What have they been doing to help him? Have they given him simethicone or any gut motility drugs?

(I just hope it isn't tumors causing this...)

 

[ldjohan]

I am picking him up right now. I will ask for the simethicone. I'm not letting him going through surgery with that extremely high risk. I'm going to do what I can here at home.
I've ordered the essential for life syringe feed for him. In the mean time I will get the critical care feed from the hospital.
Anything else that I can do for him at home?
I appreciate all the input.

 

[ticklechin]

If it is indeed a obstruction attached to the intestinal wall, surgery is the only option but the survival rate of the surgery is 10% but the short term after surgery survival rate is next to zero-there is a very high chance the remaining intestinal tract will die. I went through all the options with the vet and we both decided that euthanasia was the best.

If the obstruction is not attached then IMO supportive care is the best option, there is a chance that it can hydrate and move, I would try it first and then if nothing happens in a week or so I would be re-evaluating the situation, a new ultrasound would be done to check movement and to check if the intestines were still alive and the rate of contractions were the same. If this obstruction was located in the cecum or stomach then its a different ball game, but if it is not attached and its in the intestines then there is a small chance it can get moving. The problem is the feeding-the food is not going to go through although it can help push whatever is there along if the item becomes hydragted and soft, and there is a real chance of more fermentation and gas, a chance the intestines will rupture or twist, its just not a good situation, make sure you go over really well the supportive care with the vet and if the situtation gets worse be prepared to PTS, the chin is in ALOT of pain and also may go into shock, so prepare for the worse and hope for the best.

 

[mishellyshel]

took him there right away, and they said that most likely Charlie has obstruction in his intestine. They suggested 2 options to me:

this one sentence stands out to me. it says he "most likely" has an obstruction. what is the large bubble is just a huge gas bubble that they are mistaking for a tumor??

If so and charlie is in stasis, while it is no easy task, a chin CAN come out of stasis. It takes a lot of work, time, patience, care and a lot of hope. you can go thru all the pages of discussion on stasis. but in a nutshel it is motility drugs, gas drops, handfeeding, tummy massage, extra playtime.....repeat!

simethecone can be purchased at any drug or food store.....it is just infant gas drops. you need cisapride and/or reglan and if the chin is in any pain you may want a pain reliver like metacam. if your vet doesnt have critical care and while you wait for the essentials for life, you can actually grind up pellets and mix with water. a small dab of canned pumpkin with help with the consistancey and the pallability although if charlie has a huge gas bubble, i would use as little of anything that would make it worse. i would use a full 1 cc (the little syringe) of gas drops before you handfeed him and i would give him the gas drops a minimum of 3 times a day. the tummy massage is tough if he doenst like to be held, but you gently rub down as if mimicking the movement of food thru the intestines.
there are a ton of threads on this, i would definitely spend some time reading.

 

[ticklechin]

Large gas bubbles are found in chinchillas with obstructions-the non movement of the food in the intestinal tract leads to bacteria build up and fermentation, the gas can't move and the bubble gets large-simeticone won't help -it only breaks the gas down to smaller bubbles but if those bubbles have no where to go its ineffective and not used until the obstruction gets moving. I also do not advise mixing anything with the critical care, this chin needs fiber and critical care has proven to be the best for GI issues, but even the CC is a issue if the obstruction does not move-its a fine balancing act of feeding little but just enough to keep the chin alive.

In this case, advice needs to be given by those that have first hand experience in obstructions, and the advice is given in conjuction with the vets advice, not to replace it, this is a life threatening situation and any wrong advice can make this go down even worse than it is.

 

[ticklechin]

Gas and obstructions are very different on the x-ray-the tech is seeing a enlarged intestine-this could be from a obstruction, a tumor or a thickening of the intestinal wall, it won't be mixed up with gas in the belly.

 

[ticklechin]

Large gas bubbles are found in chinchillas with obstructions-the non movement of the food in the intestinal tract leads to bacteria build up and fermentation, the gas can't move and the bubble gets large-simeticone won't help -it only breaks the gas down to smaller bubbles but if those bubbles have no where to go its ineffective and not used until the obstruction gets moving. I also do not advise mixing anything with the critical care, this chin needs fiber and critical care has proven to be the best for GI issues, but even the CC is a issue if the obstruction does not move-its a fine balancing act of feeding little but just enough to keep the chin alive.

In this case, advice needs to be given by those that have first hand experience in obstructions, and the advice is given in conjuction with the vets advice, not to replace it, this is a life threatening situation and any wrong advice can make this go down even worse than it is.

I am sorry if the last statement seems mean, I did not intend it to be that way I am just looking out for this chins welfare so no ill will intended.

 

[mishellyshel]

i didnt take it as mean. and i appreciate you taking the time to write that. it shows that you do care.
it just seemed to me the OP didnt have definitive answer and was taking their chin home for after care, so i was posting what i would do.
i assumed they would have gotten an answer if it was blockage, tumor or gas before deciding their final course of action and taking the chin home.
hopefully they will find out what they are treating before they decide to treat charlie.

 

[Claire D]

If it is indeed a obstruction attached to the intestinal wall, surgery is the only option but the survival rate of the surgery is 10% but the short term after surgery survival rate is next to zero-there is a very high chance the remaining intestinal tract will die. I went through all the options with the vet and we both decided that euthanasia was the best.

If the obstruction is not attached then IMO supportive care is the best option, there is a chance that it can hydrate and move, I would try it first and then if nothing happens in a week or so I would be re-evaluating the situation, a new ultrasound would be done to check movement and to check if the intestines were still alive and the rate of contractions were the same. If this obstruction was located in the cecum or stomach then its a different ball game, but if it is not attached and its in the intestines then there is a small chance it can get moving. The problem is the feeding-the food is not going to go through although it can help push whatever is there along if the item becomes hydrated and soft, and there is a real chance of more fermentation and gas, a chance the intestines will rupture or twist, its just not a good situation, make sure you go over really well the supportive care with the vet and if the situation gets worse be prepared to PTS, the chin is in ALOT of pain and also may go into shock, so prepare for the worse and hope for the best.

I can't add much to Dawn's excellent advice here really except to continue to ensure the chin is getting plenty of subcut fluids - if the mass is dehydrated food due to slow gut transit time then re-hydration is key - & adequate pain relief. Extra fluids can be added orally by giving more watery feeds too (being very careful not to choke the chin or let them aspirate (inhale) the food.
Warmth is also important - a heat pad in the cage is essential because although chins normally don't like to be warm, sick chins need a little extra - they are not good at regulating their body temperature when they are sick.

I wish you & Charlie all the very best of luck.

 

[ldjohan]

Thank you so much to everyone for your thoughts and advice. Charlie is home with me now. When I picked him up this afternoon, the doctor at the hospital still thinks that surgery is the only option, but I told them since the risk is very high, I cannot justify it. The doctor understood. So I came home with the following medication:
- Sulfatrim (antibiotic) which I have to give twice daily (0.3ml each)
- Lactulose which I have to give twice daily (0.5ml each)
- Injectible pain killer Buprenex which I have to administer once every 8 hrs. (0.1ml per injection). I've never done this before, and they taught me how to do this today.
- Critical Care Feed

I asked the doctor about giving him gut motility drug, but the doctor said it's too risky for his GI condition. First I didn't see any pain killer being prescribed so I asked and the doctor gave me Buprenex which has to be administered through injection. She said oral pain killer is also too risky for Charlie's GI.

The vet that I saw earlier yesterday called and recommended me to put Charlie to sleep since I decided not to do the surgery since if there's any rupture, then Charlie will be in a lot of pain.

I forcefeed Charlie just now, and he took about 6 ml of CC.
I'm going to administer the pain killer, and his other medication, and will give him more water. He rests on top of the warmer (sock filled with rice) right now. He loves to be held in the first place so it's not a problem at all having to hold him and gently massage his abdomen.

 

[ldjohan]

It's about 3AM, I woke up to give Charlie some water. He drank about 9ml of water, then he pee. I warm up his warmer. He actually pick up his hay & eat a tiny bit of it, he played with his wheel for a few second, and groom himself. I'm glad to see he's still full of live. No poo yet, and his belly feels very hard.
I saw him crunched and his tail went up & down for a couple second in the corner, not sure if he's trying to poo? but nothing came out...

 

[Kalandra]

I have no advice, but I have been reading about Charlie, and just wanted to say he is in my thoughts. Come on baby, let's have that obstruction move and some poop coming out.

I am wondering though, did the vet's not give you any sub-q fluids to inject? It seems like every time I a chinchilla with stasis or an obstruction post on here that frequent sub-q of fluids is a very key part of their recovery. Dawn, or anyone else, am I mistaken on that?

 

[ticklechin]

Buprenex is a heavy duty opioid that is controversial in its use in stasis, bloat and obstructions since it slows the peristalsis of the digestive tract, but it offers good pain relief to stave off shock-another tightrope act in dealing with this type of issue.

The Lactulose will draw water out of the body to the digestive tract to hydrate the mass, so make sure he is well hydrated, I would personally be using sub-Q fluids but if he drinks water with no problems give him the small amounts frequently-check for hydration by pulling the scruff of the neck up and release, the skin should bounce back and not stay "pulled up".

Excercise is important to try to get things moving, I put my digestive issues chins in the bathtub and chase them around some-unless they move around on their own so get him moving, especially on the buprenex.

The sulfa drug is not a bad idea though some will disagree, the bad bacteria in the digestive tract have a perfect opportunity to grow when the gut is not moving-I use it when dealing with this issue.

 

[ldjohan]

Thank you Kalandra & Dawn. Those are excellent feedback on the medication. The doctor said as long as I give him water, he doesn't need the sub-q, but she will give it to me if I ask her to. Should I? Can you tell me what is the difference between drinking water vs the sub-q?
No wonder he's been peeing a lot. Now I know the lactulose is causing it. I've been giving him water every 4 hrs or so for about 6ml each time...plus when he eats the CC, I made it a little on the watery side.
I will definitely get him moving more! Thanks again.

 

[ticklechin]

Because the lactulose is removing the water from the body the chin can easily become dehydrated and not be able the take in enough liquid water to compensate, hense the use of the sub-Q fluids, to prevent dehydration. If he is taking his water well from the syringe, keep a eye on him for now and look for signs of dehydration I listed. Is his pee clear, light yellow or orange?