Gizmo - Full Write-Up

Gizmo was one heck of a fighter! He suffered from chronic respiratory disease; one of the most common diseases amongst mice and rats. 

Arrival:

Gizmo arrived cohabiting with 3 other entire male rats, Trev, Crumbs, and Norman.

Unfortunately, due to severe neurological illness, Crumbs had to be euthanised within 24hrs of arriving. Gizmo and Trev suffered from CRD - Trev being the most severe.

The poor boys went through so many lifestyle changes when they arrived, but handled everything in their stride.

Within a few days, it became clear that Gizmo was the top-rat. He was incredibly territorial at times, but Norman and Trev mostly knew how to stay out of his way.

Unfortunately, Trev became extremely unwell as his disease worsened. There became a day when we had to make the decision to have him humanely euthanised - leaving Gizmo and Norman together.

Throughout his time here, Gizmo was no picture of health himself. As we've mentioned, Gizmo faced numerous challenges due to CRD himself. Eventually, there became a point when his disease started to take a toll on his wellbeing too.

Gizmo's Medical History:

We are not able to diagnose or recommend treatment if your animal is sick. If your pet is unwell, please seek advice from a qualified medical professional who is experienced with your animal.

The following section will be discussing Gizmo's treatment.  Treatments mentioned are not to be substituted instead of seeking medical treatment for your animal.

Firstly, we cannot stress enough how challenging it can be to manage rats or any animal with a chronic respiratory disease. Not only does the medical costs often mount up, but your husbandry cannot slip either. Keeping their enclosure in top condition is paramount to managing respiratory diseases. Ensuring the surrounding environment doesn't have any irritants, and that you do not cause undue suffering of an animal.

Since losing Gizmo, we've continued to learn ways to improve our quality of care. We will make sure it's clearly highlighted if we've since found a method of practice outdated, but we will tell you what we did exactly at the time.

Initial Diagnosis:

When Gizmo arrived, he had an incredibly raspy audible (without auscultation) respiratory noise. We've found occasional sneezing and minor congestion to be normal, especially when a rat has recently changed environment. Gizmo's symptoms were suggestive of a respiratory infection and had symptoms attributable to a chronic illness, meaning his symptoms had possibly been present for some time.

Gizmo's diagnosis was based on clinical symptoms and owner reports. Diagnosing respiratory diseases can be a challenge; obtaining an accurate culture/representation of respiratory pathogens can be difficult. Studies suggest most cases of CRD are the result of numerous pathogens. In rats and mice, mycoplasma is ubiquitous and by far the most common infectious agent.

Initially, we tried nebulising F10 antiseptic solution BID, but he failed to respond.

Our veterinarian then advised nebulising Baytril/Enrofloxacin (fluoroquinolone antimicrobial agent) and Ronaxan/Doxycycline (tetracycline antimicrobial agent) with normal isotonic saline (0.9% NaCl) for a minimum of 30-days. It was likely Gizmo had an upper-respiratory infection.

We later nebulized Bisolvon/Bromhexine (bronchial mucolytic) and Corvental/Theophylline Ph. Eur - our current veterinarian discourages this method of administration, although we're using the drugs off-license, it's recommended to administer them via their licensed route, which is oral. Nebulising only works with molecules of finite size, Bisolvon and Corvental may have particles too large to receive the full therapeutic effect by nebulising.

Gizmo was also prescribed oral Metacam/Meloxicam (NSAID) to help alleviate pain and discomfort caused by the persistent infection.

As Gizmo was approaching the end of the 30-day course, he was still presenting with many symptoms, albeit they'd improved substantially. Rather than discontinuing antibiotics and potentially building resistance, the vet wanted to continue the course for a further 2-weeks until symptoms subsided.

By the end of the 6-week course, Gizmo's CRD was controlled, and he was considerably happier. He required ongoing daily nebulising sessions with isotonic saline to prevent further relapses.

Relapses:

Owners must be prepared for potential relapses when dealing with chronic respiratory diseases. Not all patients experience relapses, but many do.

During Gizmo's relapses, he required more aggressive medicinal therapy to improve his symptoms. He suffered epistaxis (nasal bleeding), severe pain, increased respiratory effort leading to subsequent weight loss, and secondary parasitic infection as he was immunocompromised.

Images demonstrating epistaxis and severe pain.

Gizmo displayed severe symptoms suggestive of pulmonary neoplasia or abscess. Given the grave prognosis with such health concerns, our vet recommended we take some X-Rays. There was the added risk of respiratory arrest given Gizmo's condition, but we didn't want to prolong his suffering if there was no chance of recovery.

Radiographs highlighted chronic inflammatory changes to pulmonary tissue but did rule out neoplasms and abscesses.

Gizmo was introduced to a 6-week course of nebulized Ronaxan/Doxycycline (tetracycline antimicrobial agent) and Baytril/Enrofloxacin (fluoroquinolone antimicrobial agent). Given the inflammatory changes, he was introduced to subcutaneous Dexadreson/Dexamethasone bisodium phosphate (corticosteroids) injections.

Once Gizmo appeared more stable, he was gradually weaned off corticosteroids and onto NSAIDs as they're far safer to use long-term.

Gizmo fully recovered from this particular relapse.

Second Relapse:

Each of Gizmo's relapses were harder to manage than the last. 

Gizmo suddenly presented with secondary aggression towards his cage mate - Norman -resulting in it being safest to house him alone (a decision we do not take to lightly), epistaxis, and signs of pain.

We introduced Gizmo to nebulized Baytril and Ronaxan with F10 antiseptic solution - we no longer use F10 to create nebulized antibiotic suspension. As F10 is an antiseptic, we've since noticed that it sometimes reduces the efficacy of antibiotics, therefore, reducing the desired therapeutic effect. We now use hypertonic or isotonic saline for nebulized suspension.

Gizmo was introduced to 0.5mg:1kg oral Metacam and oral Tramadol Hydrochloride to alleviate pain and inflammation.

Once he appeared more stable, we attempted to reintroduce Gizmo to Norman. Unfortunately, the introduction failed, Norman was then introduced to our other mischief of bucks to prevent depression from isolation.

Due to the risk of injuries, Gizmo remained alone.

We decided to have Gizmo castrated once his CRD was controlled. We decided it was worth trying to prevent depression from isolation - which could exacerbate his disease.

The surgery was a success! Gizmo was already on the required medication to help with his recovery. He was housed in an adapted accomodation to minimise the risk of injury and infection.

Antibiotics were discontinued after 4 weeks as Gizmo appeared to be stable.

Final Relapse:

Only two days after Gizmo finished his course of antibiotics, his upper and lower respiratory infection returned - considerably more severe too.

He was introduced to nebulized F10, Baytril and Ronaxan suspension BID, nebulized saline (0.9% NaCl) and Gentamicin (aminoglycoside antimicrobial agent) suspension TID, and nebulized saline (0.9%NaCl) and Dexadreson/Dexamethasone Bisodium Phosphate (corticosteroid) suspension BID. The vet also increased Gizmo's nebulized Corvental/Theophylline Ph. Eur. (bronchodilator) dose from BID to TID.

Gizmo showed minor improvements, but we decided it was appropriate to add in a fourth antibiotic. He was introduced to oral Azithromycin (macrolide antimicrobial agent) BID for 7-days, then reduced to QD for 7-days.

Despite our best efforts, Gizmo's quality of life was irretrievable. We decided it was kindest to have him humanely euthanised.

Gizmo passed away on the 17th of July 2019.