Crumpet, Gizmo, Norman, and Trev

We wanted to write a lengthy post regarding 4 rat bucks we agreed to provide sanctuary for on the 7th November 2018 - Crumbs (Crumpet), Gizmo, Norman, and Trev. Their previous owner contacted us as they were no longer able to accommodate their pet rats. Unfortunately, the rats had pre-existing health complications which needed to be dealt with upon arrival.
We will separate the post into labeled sections based on the individual rat.

Norman:

Norman is a beautiful buck rat. He was approximately a year old when he arrived. Norman sounded slightly congested. So, he and his mischief went to the vet. His lungs sounded quite clear when auscultated and his respiratory effort was normal. His stuffy respiration was likely attributable to his upper airways, rather than his lower airways. Despite some of Norman's symptoms, we didn't believe an infection was present, thus no reason to warrant prescription of antimicrobial agents. We suspected he'd show improvements once he'd been introduced to strict prophylactics, particularly those to aid respiratory issues. We did, however, briefly introduce Norman to nebulized F10: a multipurpose antiseptic solution used as an effective preparation against a wide range of bacteria, fungi, viruses, and spores. We discontinued nebulization therapy after Norman showed significant improvements and became asymptomatic. He's since been well-managed and has, fortunately, had no further relapses to suggest an underlying chronic respiratory issue.

Gizmo:

Gizmo is the man in charge and doesn't let the other rats forget it! Gizmo has a chronic respiratory disease which has required hands-on medicinal management throughout his time here with us.

When Gizmo arrived, his respiration was incredibly audible - even without auscultation. After failing to respond to nebulized F10, he was introduced to a 30-day course of antibiotics: Ronaxan/Doxycycline (Tetracycline class antibiotic) and Baytril/Enrofloxacin (Fluoroquinolone class antibiotic). Gizmo had a respiratory infection and had been displaying symptoms attributable to chronic respiratory disease. It's often difficult to get an exact culture/representation of the pathogens responsible for the cause of infection in the respiratory tract. In fact, studies suggest that respiratory diseases are mostly the result of multiple pathogens. 'Pathogen' refers to a bacterium, virus, or other microorganisms that can cause disease. 
Enrofloxacin and Doxycycline are two broad-spectrum antibiotics. Broad-spectrum antibiotics generally work in one of two ways. Some antibiotics work on two major bacteria groups at the same time - gram-positive and gram-negative. Or, they can work on a wide range of pathogenic bacteria. Although broad-spectrum antibiotics provide invaluable help, limiting their overuse is equally as important to help tackle resistant microorganisms. 
It's also more effective to use both Enrofloxacin and Doxycycline together when tacking pathogenic mycoplasma. Mycoplasma are a mollicute genus of bacteria that lack a cell wall around their cell membranes, they're naturally resistant to many common antibiotics, such as penicillins, due to their lack of a cell wall. Mycoplasma pulmonis is a species-specific organism carried by nearly all pet rats (and mice). Mycoplasma pulmonis colonizes in the respiratory epithelium. Studies suggest it is, to date, the only significant species of mycoplasma to cause disease in rats.

Based on some symptoms Gizmo had presented, he was later introduced to Bisolvon (bronchial mucolytic) and was also supported with Metacam/Meloxicam (NSAID) to help alleviate inflammation and discomfort.

As Gizmo was reaching the end of his 30-day antibiotic course, he was still demonstrating signs of infection, albeit he had improved. We feared discontinuing antibiotics too soon would contribute to antibiotic resistance. The vet decided it was appropriate to extend Gizmo's course by an additional 14 days, making it a 44-day course (6 weeks) in total. He later trialed with Corvental/Theophylline Ph Eur (bronchodilator) to help widen his airways.

Fortunately, towards the end of his 6-week course, Gizmo seemed much brighter and happier within himself with nearly all respiratory symptoms having subsided. Gizmo continued to have daily nebulization therapy with respiratory medications.

Gizmo, like most rats with a form of CRD, has experienced relapses throughout his life which has meant that more aggressive management has been required on occasion. 

Recently, Gizmo suddenly began demonstrating clinical signs of considerable pain, had an increased respiratory effort and subsequent weight loss, epistaxis (nasal bleeding), and due to being immunocompromised, had developed a parasitic infestation.

Gizmo demonstrating signs of pain and epistaxis.

Despite the increased risk with anesthesia when also dealing with a respiratory infection and uncontrolled CRD, Gizmo was admitted for radiographs due to concerns of a lung tumor(s) or abscess(es). We still felt that it was necessary given the poor prognosis with either of those potential scenarios.

Fortunately, Gizmo's X-Ray didn't reveal any large masses or abscesses. It did, however, show chronic inflammatory changes to the lungs - likely as a result of his CRD. Alongside introducing him to Doxycycline and Enrofloxacin again (initially 4 weeks but we extended it to 6), Gizmo was briefly introduced to intermittent subcutaneous injections of dexamethasone: a corticosteroid with potent anti-inflammatory properties. Once Gizmo seemed more stable, he was weaned off steroids and back on Metacam/Meloxicam (NSAID) as it is much safer to use long-term.
As of today, Gizmo is recovering well and nearly finished his course of antibiotics. 

Crumpet:

When Crumbs arrived, it immediately became clear that he had severe undiagnosed neurological abnormalities.

We suspected that his symptoms could've been attributed to a pituitary tumor (or other brain tumors), brain lesion(s), and/or brain abscess(es). Without magnetic resonance imaging (MRI), it would be impossible to accurately diagnose.

Clinical symptoms included: 

• ataxia (lack of coordinated movements)
• walking in circles/inability to walk in a straight line
• unequal/unilateral eyes (often associated with retrobulbar abscesses and tumors)
• opisthotonos (throwing head in circles)
• frequent episodes of panic due to a chronic falling sensation
• loss of control of bowel and bladder
• partial seizures
• suspected blindness (vision was tested despite there being no official diagnostic test developed specifically for rats)
• hypodipsia (abnormally decreased fluid intake commonly associated with brain lesions)
• inability to balance
• severe headache - likely stemming from compression of the brain
• abnormal coat thinning and changes to the skin (hormonal changes commonly associated with pituitary tumors).

Visible changes to Crumbs' coat and skin.

Crumb's passing:

Despite Crumbs' health seeming irretrievable, we were advised by our veterinarian to trial him on Cabergoline: a dopamine receptor agonist with a direct influence on pituitary lactotroph cells, therefore, meaning it can shrink some tumors, however, early intervention is often far more promising. We also introduced him to a high dose of oral Prednisolone: a corticosteroid with predominant glucocorticoid and low mineralocorticoid activity. If improvements were not seen after 24hours, euthanasia was advised.  

Ultimately, we decided it was best to have Crumbs humanely euthanized so we could put an end to his undeniable suffering.

Crumbs peacefully passed away on 8th November 2018.

Trev:

Trev was a sweet and laid back buck, but despite his gentle nature, he was a warrior. From the first veterinary assessment, it was strongly suspected that Trev had a chronic respiratory disease. He had an increased respiratory effort (labored breathing and use of accessory muscles to breathe), audible respiration even without auscultation, poor coat condition, and was underweight - likely due to increased respiratory effort.

Before jumping straight to antibiotics, we decided it would be appropriate to trial Trev on nebulized F10 first. F10 is an antiseptic preparation; it can be used to prevent the growth of disease-causing microorganisms. Nebulizing turns medication into a form of a breathable mist which is then directly inhaled to the lungs - particularly the lower airways. 

Not too surprisingly, Trev did require the use of antimicrobial agents. He was introduced to a 30-day minimum course of Baytril/Enrofloxacin in combination with Ronaxan/Doxycycline suspended in isotonic saline (0.9%NaCl) - studies show the benefits of using hypertonic saline in comparison to that of isotonic saline for respiratory diseases is largely negligible. We also decided it would be appropriate to introduce Trev to a non-steroidal anti-inflammatory to help with any underlying inflammation of the lungs, he was trialed on Metacam/Meloxicam at 1mg:1kg dose. 

To combat Trev's ongoing weight issues, he was introduced to a high kcal soft food to ensure he was consuming enough calories. With his body using more energy to simply breathe, he would subsequently burn more calories, thus needing a higher calorie intake than a healthy rat.

After a promising start, Trev's improvements began to stagnate. He had a persistently high respiratory effort despite his infection showing signs of improvement. 

Video showing Trev's labored breathing.

As Trev had been living with a chronic respiratory disease for some time, possibly even an untreated infection, he'd likely accumulated lung scarring. Often, lung scarring is permanent, but steroids have been shown to reverse scarring in some cases. After discontinuing non-steroidals, Trev was introduced to a low dose of nebulized prednisolone (corticosteroid). He was also introduced to Corvental (bronchodilator containing Theophylline Ph. Eur.). Theophylline is also known as 1,3-dimethylxanthine. 1,3-dimethylxanthine is a methylxanthine drug and is commonly used in therapy to treat a wide range of chronic respiratory diseases. Bronchodilators widen the airways by relaxing the muscles, therefore improving airflow.

Unfortunately, the lower dose of Prednisolone proved to be unbeneficial for Trev, the dose was then increased and administered more frequently. The higher dose proved much more beneficial.

Trev's antibiotic course was extended to 6-weeks/45 days as he remained symptomatic. As he still had flares of audible respiration, we also introduced Trev to Bisolvon (bronchial mucolytic). Bisolvon belongs to a class of drugs known as mucokinetics. This drug class aids in the clearance of mucus. As Bisolvon is a bronchial mucolytic, it helps loosen thick secretions from the bronchi: air passages from the lungs which diverge from the windpipe. Eventually, he was steadily weaned off steroids and he finished his course of antibiotics.

Although Trev's health wasn't perfect, nor would it ever be, we were able to manage him well for a long time. It is known that chronic respiratory diseases generally worsen with age. This is because the patient will deal with frequent infections over time. Chronic antibiotic usage leads to antimicrobial resistance making recurrent infections harder to treat. This leads to further lung scarring, making them fibrotic, thus making it harder to create sufficient airflow. Insufficient airflow can create lower blood oxygen levels. This vicious cycle of issues increases the developmental risk of hypoxia. Ultimately, that's what happened to Trev.

Trev's passing:

Trev developed a severe respiratory infection, he was introduced to his 'usual' drugs including; antimicrobial agents, mucolytics, bronchodilators, and corticosteroids. Despite these drugs proving to be beneficial in the past, Trev only worsened. His respiration became more labored as each day went by, consequently, rapid weight loss was observed. Trev was introduced to daily subcutaneous Dexamethasone (corticosteroids) injections to help combat his worsening symptoms. Dexamethasone is a potent steroid which provides fast-acting anti-inflammatory relief in various parts of the body.

Despite aggressive medicinal therapy, Trev started to experience episodes of cyanosis as a result of hypoxia. Hypoxia occurs when the body doesn't have adequate oxygen. It's an extremely critical condition which can cause fatal damage to organs within minutes. Hypoxemia (low blood oxygen levels) can trigger Hypoxia (low tissue oxygen levels). Symptoms of the two vary from each patient. Cyanosis refers to a bluish (cyan) discoloration of the skin, in Trev's case, this occurred as a result of inadequate oxygenation of the blood. Trev was introduced to high-flow oxygen therapy whenever severe episodes occurred. Sadly, despite all of our efforts, he continued to deteriorate.

Trev eating his weight gain porridge.

We had to face the music. Trev's lung capacity was poor and his body was failing him as a result, despite hands-on treatment. Alongside severe lung scarring, a large lung abscess was also suspected given the positive correlation between lung disorders and high levels of NH3 (ammonia) - which were present in his previous home. Radiographs (including the lateral view) would've been beneficial but the risk of respiratory arrest under anesthesia was far too severe given Trev's state at the time. Even with the x-rays, the prognosis was equally as poor.
We decided the kindest option for Trev, was for him to be humanely euthanized. 

Trev peacefully passed away on 4th April 2019.

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If you have any further questions, do not hesitate to email us: bacchusresidents@outlook.com