QUESTION: Hi Debbie
I'm sorry to bother you again but Luna is still unwell. She has been on Doxycycline since Tue 26th Feb so 8 days today. I also started her on Baytril on Fri 1st March so this is her 5th day today. She has been to the vets everyday since Sat for a 0.5mg injection once a day of dexamethasone. This has helped because all day Sat she was literally gasping for breath now she can breath but the noise is very loud and sounds wet not like the pigeon noises she made last time she was ill. I am on my own as of today no more injections the vet wants me to start prednisolone 2.5mg once a day for 3 days gradually weaning her off. She is taking her meds in chicken paste and porridge made with water but I think thats the only food shes eating (I could be wrong because obviously I have to sleep and I can't watch her 24/7). She has lost almost 100g since this started back in Feb. But she was fat weighing 513g she now weighs 415g which I suppose is a better weight for her but I really don't want her to lose anymore! The main reason for this e-mail is to ask you if you would add in another antibiotic such as Amoxicillin on top of the others or do you think that the side effects of three would be too much for her. If so which one of the other two would you drop i.e. Baytril or Doxycycline. I just feel that although she isn't gasping for breath anymore she still isn't well and could this be the side effects of all the meds shes taking or a secondary infection I don't know how I can tell would she have a temperature? My vet has worried me because he said that now shes on the steroids it will be more difficult to know if an infection is present because she will not exhibit the normal symptoms. It is so unfair to her I hate to see her like this she really is such a little sweet pea and a real fighter but would it be kinder to put her to sleep now as she has been trying to fight this since Oct 2012 and I don't know if the meds are helping and she can't tell us what she feels like its so sad :( Please advise.
ANSWER: Hi Karen,
I'm glad the vet wants to put her on oral prednisolone, as I'm sure that is what she needs, since the dexamethasone has helped her. But I'm very concerned that he only wants to do it for 3 days. How old is she? Once a rat gets to the point where they need steroids to keep their lungs functioning properly, they usually need it for the rest of their lives. I know some vets are concerned about keeping them on the steroids long term, but in my 28 years of experience, I have never had any negative effects of keeping them on the steroid long term if they need them. As long as they are also on an antibiotic, they do not have an elevated risk of infection, so this is not something you need to worry about.
It certainly would not hurt to try the amoxicillin. You don't need to stop either the Baytril or doxy. Even if the amoxi doesn't improve her symptoms, you could leave her on it the rest of her life to protect her from secondary infections, as long as she doesn't have a bad reaction to it.
If she still has symptoms after being on the prednisolone for 3 days, then she probably also needs additional medications, such as a bronchodialator, and/or heart medications. Do you have my Rat Health Care booklet? Have you shown it to your vet? If not, I recommend printing out the article about Respiratory and Heart Disease from my website at www.ratfanclub.org on the Rat Info page to show your vet, or emailing the link to him.
You said you don't know if the meds are helping her because she can't tell you, but she certainly can tell you by her behavior. If the meds help, her symptoms will be better and she will seem to be feeling better. If the meds aren't helping there will be no change or she will be worse. See how simple that is? You need to keep trying different medications to see if they will help. However, she should stay on either the doxy or Baytril or both because we know they help myco. However, the antibiotics often aren't enough by themselves, and they need additional medications to help their organs work properly because of the damage caused by the myco. Please try to be assertive with your vet. You are in charge of Luna's care, not the vet. If she is not feeling well enough, then you need to keep trying new medications until she is. If you've tried all the medications possible (that I recommend) and she isn't better, then you do need to euthanize her.
[an error occurred while processing this directive]---------- FOLLOW-UP ----------
QUESTION: Thank you Debbie so much for all your help. You asked how old Luna is she was 2 years on the 2nd March. Also my vet would just like to give her the lowest dose of prednisolone possible that would keep her symptoms under control. Hes happy to keep her on them if I want. He has been brilliant actually because I don't really think hes dealt with many rats at all. We really dont know enough about them in England but I have learnt so much from sites like yours and others on the web. He also said I could add in the Amoxy if I wanted to hes sort of just being led by me which is great really because I can give him the information from someone like you and hes willing to accept it not many vets do in my experiance. I will email him your link. Just one other thing please I did ask him if he thought there could be a problem with her heart that was causing the breathing problem he said he didn't think there was but how can you tell if its heart of respiratory? Are there certain things to look out for?
ANSWER: I'm so glad your vet is willing to follow my recommendations! Congestive heart failure is quite common in older rats, and the way you tell is by the response to treatment. So start her on the oral prednisolone, and try it for a while until you figure out what is the best dose that helps her. Then if she still has symptoms, try her on the enalapril, and if she gets better, then you know that she has heart disease. Then, you want to put her on both the enalapril and atenolol. It's okay for a at to be on many different medications at the same time as long as they are all helping.
---------- FOLLOW-UP ----------
QUESTION: Hi Debbie
Please could you tell me the correct doses for Luna on this list of medication Luna now weighs just under 400grams :
Baytril, Doxycycline, Clavaseptin (amoxicillin) and also
Enalapril and Atenolol please thank you :)
Okay, just under 400 g is between 3/4-lb and 1-lb, so for the antibiotics, use the 1-lb dose.
Baytril 10 mg
doxycycline 2.5 to 5 mg
amoxi 10 mg
all twice a day
The heart meds are also very safe, and we really don't know the exact best dose, in fact, I think maybe the dose should be higher than what's in my booklet, so you can use the 1-lb dose for them too. In fact, you might need to use more if they help, but not quite enough.
enalapril 0.25 mg
atenolol 1 mg