Early one Friday night this fall, my male glider
Petey made a really unusual sound - it was a lot like a fighting or mating
squabble sound, but it had what I can only describe as a "pained quality".
I knew something was wrong, and ran in to see what was up. I found
Petey curled up into a ball
with his mouth near the base of his tail, rolling around on one of
his cage shelves. As I rushed to open the cage, he actually rolled
himself right off the shelf, yet kept up the rolling and the sound.
When I reached in and grabbed him, he gave me a hard bite - something he
had never done before. I looked him over, and his anus appeared red
and slightly swollen. I stayed up with him, and he had several other
such "attacks". In between, he acted completely normal, which was
really baffling at first. It became apparent that he was biting at
his anus whenever he urinated or defecated - it was causing him pain.
To his credit, it seemed like he was trying to hold himself back from actually
biting himself much of the time - as though he knew that would only make
it worse - but he still nailed himself good a couple of times, drawing
a tiny bit of blood and making a visible flap of loose skin. Luckily,
it wasn't serious damage, but it was scary nonetheless.
We had read a lot about self mutilation, as well as hearing about the un-named and incurable nematode that could be responsible, and we were terrified. We stayed up with him all night, holding him in a cloth to keep him from biting himself (getting bit ourselves several times in the process), and got him in to the vet the next morning. She did a fecal, a general exam, and put him on Panacur (a general wormer) and Pediapred (an anti-inflammatory) for the holiday weekend (three days worth). She advised us that she had seen many cases of self mutilation in the past, which were caused by an unnamed nematode discovered by her and two vets from California. She started to prepare us for the worst, telling us that if this was caused by the nematode, there was no cure.
We were emotional wrecks - we simply adored this little guy. My husband (Charlie) and I were sleeping in shifts so that we were awake with Petey 24/7. Even when it was Charlie's shift, the sound of Petey having an attack instantly woke me - many times I was halfway down the hall before I was even fully awake. His cage-mate, Weezer, seemed to be worried and afraid too. Our vet called us periodically to see how he was doing over the holiday weekend. He seemed to be getting weaker, and spent much of his time sleeping when he wasn't having an attack. I cried all weekend, holding my little guy and praying for a miracle. Such a sweet, special little guy shouldn't have to go through such a horrible problem. He seemed to be slipping away from us.
Over the weekend, I had contacted Bourbon to
see if she had any information to help. Bourbon told me that if we
could stop the chewing, we were doing well, but she also mentioned that
no one had been able to do that. She told us to have a urinalysis done
to check for a yeast infection or bladder/kidney
infection, a fecal test done to rule out parasites, and also a bacteria
culture. She gave us some factors that could be contributing causes,
including galvanized wire in the cage, or a nest box or other item
in the cage with rough edges that could have caused a scrape.
She also asked us to give her some details of his environment, diet, age,
etc. to help the research efforts.
After the weekend with no change for the better,
we took Petey back to the vet early Tuesday morning. The vet was
going to have to put him under to draw some blood and do a thorough exam
and x-ray. She made it painfully clear that anesthesia is very risky
and he may not make it through
the procedure. It took everything I had to leave him there -
I sat in the parking lot and cried my heart out, afraid that the next time
I saw the little guy, he would be gone.
The vet did a urinalysis, another fecal, bacteria
culture, drew blood for testing, and did an x-ray. While he was under
anesthesia, she extracted his penis and looked it over to make sure there
weren't any cuts or scrapes on it. She checked his skin to make sure
there were no mites or other signs of external parasites or injuries.
She thought it could be bladder stones being passed, which would not only
be painful, but could also leave scratches that would be irritated by urine.
When I went to pick him up, the vet told me that Petey had a really hard
time coming out of the anesthesia -she hadn't been sure if he was going
to come to for a while there. Again, she seemed to be preparing us
for the worst. When we asked about an e-collar for him, her assistant
looked at us sadly and said "it's really not going to
help him". The vet also started preparing us to consider a necropsy,
telling us "if he doesn't make it, put him in a ziploc bag in the refrigerator
and call me immediately". While I understood the benefits to science
and to other gliders, this seemed to be heartless and negative. She
told us not to bother
staying up with him, and not to try to keep him from biting himself
- that if it was self-mutilation, there was no way to keep it from happening.She
seemed to be sure he wasn't going to make it. I wasn't ready to give
up hope.
The urinalysis was negative for infection,
the fecal and skin test didn't show any parasites or mites, and the x-ray
showed that his kidneys and liver were normal size and looked fine.
I also asked how his bone density looked, and it was fine.
I told Bourbon that night that I was really
hoping they would have come back with something conclusive, so we at least
knew what we were dealing with and what to do. Having the vet and
the assistant be so negative about his prognosis was painful and disheartening.
Thank God for Bourbon's support - having someone give me things to consider,
some questions to answer, and being supportive and hopeful was exactly
what I needed.
Lanacane had been suggested to us, but the vet said that if it
came to that, it was better to get straight lidocaine from the vet, as
the other ingredients in Lanacane could be harmful to gliders. It
was also important to only use that in extreme circumstances, because they
tend to lick whatever you put on them, and lidocaine numbing of the tongue
would keep them from eating/drinking, and could also cause a nasty tongue
bite. She also told us not to use vitamin E oil, unless it was seriously
diluted with baby oil (1 drop to 10 ratio), as vitamin E is toxic to pets.
No yeast infection was found. She also mentioned that if it was an
allergy or reaction to the copper, the Pediapred he had been on would have
been dealing with that. We were "on hold" for 24-48 hours to find
out the lab results. In the meantime, Petey was still going at himself,
and we were still physically preventing it - Charlie and I both bore the
bites to show for it. The vet had given us Baytril (an antibiotic)
and Pediapred (1cc of the combination twice a day for five days).
He was sleeping more and more. It was very difficult to give him
his medication, but we had worked out a two person method - one of us would
hold him entirely wrapped in a cloth, with a thumb gently tipping his head
back (which opened his lips a little), while the other would gently work
the dropper against his side/back teeth until he opened his mouth.
We learned to squirt in a little at a time, as a big mouthful was easy
for him to spit out. He was still eating really well, despite his
general lethargy. When I had mentioned this to the vet, she told
us that the wormer he had been on often caused animals to be very sleepy
and lethargic (would have been nice to know that up front!).
He was still having frequent attacks - about every 20 minutes (whenever
he urinated or defecated) - and things didn't look good. We were
hoping the antibiotic would do the trick.
After talking to Bourbon about his diet, cage,
etc., we made some changes. I changed his water to bottled water,
with a small amount of Pedialyte mixed in. If you ever need to use
this, I recommend getting the Pedialyte popsicles instead of a bottle of
it - you use so little at a time, and a full bottle is only good for a
short time. The popsicles can be kept much longer. I also adjusted
his diet somewhat to make it less acidic (he had been eating raspberries
every night). The cage had come with a gorgeous copper roof and nest
box - we were afraid that the metal may have caused a chemical reaction
when urinated on, so we promptly removed them. Upon doing a "cotton
ball test" (running a cotton ball over all the surfaces in the cage), we
saw that there were some edges in the cage that we hadn't realized were
rough - this led to the removal of two shelves, a rough rope, and a chunk
of cholla wood.
While Petey was ill, we had been keeping him in the travel cage while our female stayed in the main cage. We did this both to make it easier to get him when he had an attack, and also in case the problem was caused by an illness or parasite she could catch. Bourbon pointed out that the separation could be causing more anxiety than good, and we put them back together (they loved on each other and chattered happily when reunited). I also took this opportunity to do an extremely thorough cleaning of the cage, with antibacterial dish soap and vinegar, rinsing several times. I also replaced the shelves with branches cable-tied in (these were a big hit!).
Charlie got some moleskin and a clear plastic
report cover from the drug store, and set about trying to make an e-collar.
He went through a dozen versions before coming up with a small version
that was lighter weight and allowed Petey to drink, but not bite himself.
The poor little guy looked like he had a shot glass stuck on his neck!
He had a hard time keeping it lifted, and it would catch on everything,
but the little trooper still was playful. As the wormer medication
worked through his system, he started
getting more alert. Weezer, our female, kept trying to help him
take the collar off - even to the point of putting her little foot on his
head and pulling at it with both hands. He stood there patiently
the whole
time. When we told the vet on one of her check-in phone calls
that we had made a collar, she advised us to leave the e-collar on
for three or four days, until he was no longer hissing when he urinates/defecates
(implying any irritation is healed up), then remove it and see what happens.
She also
mentioned we could remove it for him to eat (he was really having a
hard time with that). Her main caution with e-collars on sugar gliders
is to watch carefully to make sure they aren't becoming depressed.
Depression could lead to a swift decline.
She also mentioned that it's possible his biting was a behavioral problem (but I didn't think so because it had a cause - when he peed/pooped). If that's it, though, she said it can be treated with Amitriptyline, which is an anti-anxiety/anti-depressant medication used effectively in humans and dogs.
We removed Petey's collar for a while each night so he could eat. Charlie would rub his little neck and apologize for making it hurt, which Petey just ate up. The collar was working - which meant we could get a little sleep for the first time in almost a week. We kept Petey in the travel cage on the bedside table right next to my head at night, and the sound of him playing and clunking the e-collar around was music to my ears! We couldn't leave Weezer in with him at night, because the smart little girl had learned how to peel off the moleskin. The collar demanded so much of Petey's attention that he didn't even cry when he had two bowel movements - a success!
The blood results finally came in, and indicated
that his red blood cell count was normal, but that his lymphocytes were
more than double what they should be (should be less than 40% of blood
volume, his were at 88%). This could mean a tumor (lymphoma), though
it would take further testing later to
determine if that was the problem, or if the lymphocyte count was inflated
because of the medication he had been on. Everything else in the
blood was listed as "relatively normal", and she saw nothing else that
caused any concern. If it was lymphoma, the Pediapred he was already
on is one of the common treatments. However, that's not curable,
though it is one of the most treatable forms of cancer. It can be
pushed into remission using cortizone, but that would likely only buy him
a few weeks to months or so at most.
The vet also talked with us more about the
un-named nematode. She told us that at this point there is no other
way to diagnose it than post-mortem, or if you're lucky enough to get one
egg in the fecal test. She said in the cases they found, there were
very few eggs (about 6) in the entire digestive tract. It's not really
an irritation causing the biting, but the migration of an egg through the
blood stream to the brain, where it hatches, and then lays more eggs in
the brain. These hatch, which cause neurological
problems, which leads to the self mutilation. Once the neuro
signs are there, it's too late to do anything - there is no cure.
The vet told us that they believe the nematode originally came from wild-caught
gliders imported from New Guinea, and that they think it's transferred
from mother to child. This made me wonder why gliders aren't wormed by
the vet when they are young, like puppies and kittens are. The vet
also mentioned that it's hard to even see patterns of where this is occurring
in the US because many owners don't make it to the vet in time or tell
the vet when one has died, much less have a
necropsy done so they can document the case.
We went into a pattern of leaving the collar
off during the day while he slept if one of us could work from home that
day, then putting it back on for the night after he'd eaten. He seemed
to be getting better, and the attacks were fewer and farther between.
We let him spend one full night with the
collar off, and did not have a single attack. Charlie thought
this was a little anniversary gift from Petey to us, as that day was the
10-year anniversary of the day Charlie and I had first met. We put
the
collar back on the next morning so we could go to work. When
Charlie got home, he took the collar off, and Petey had an attack almost
immediately. Back on the collar went. The next day, he peed
at least six times without incident (and believe me, we held our breath
each time). The attacks were coming
much less frequently, and didn't seem to be as frenzied. Maybe
it had been just an injury that was bothering him, and the collar and medications
were giving him a chance to heal? After all, he was in the very early
adolescent stages, and his privates could have started to poke out and
been scratched. If
that was the case, and the acidic diet was making it more painful when
he urinated. We were afraid to even say it out loud, but we were thinking
to ourselves "maybe we can beat this thing after all".
Finally, after a week of 24/7 monitoring, we put Petey back in the main cage with Weezer for the first full night without his collar. I woke up often to check on him, but he did just fine. I started to finally breathe a little easier.
A couple days later, we received a copy of
Petey's pathology report. The following are direct quotes from the
report that may be useful to a vet dealing with a similar situation:
His platelets were clumped, but appeared to be in the normal range.
His white blood cell estimate from the smear appears to be 14-20,000.
The following came up on the "differential" --
segmented neutrophils=8%, lymphocytes = 88%, monocytes = 3%, Eosinophils
= 1%,
Polychromatophilia = ABN 2+.
Lymphs are small and well differentiated.
Recommend rechecking CBC in the future to rule out chronic lymphocytis
leukemia.
Again, the vet said that the high lymphocyte
count (normally less than 40%)could be due to the cortisone in one of his
medications. She suggested that we may want to recheck him down the
line if we were still concerned, to see if this had changed. She
suggested we wait at least a month to
do this so he could recover from his illness and rebuild the lost blood
that she drew for testing. We have decided not to pursue additional
blood tests unless there is definite medical need, because it would require
that he be anesthetized again. Since he barely made it out from the
last time he was put under, we're not willing to risk it.
We were also told to watch and make sure he was urinating and defecating regularly, as sometimes these injuries can end up causing scar tissue that blocks the bladder or anus. The glider will seem to be doing fine for a while, then die suddenly about two weeks later. Thankfully, Petey was as regular as a little clock.
On September 24, we celebrated passing two
weeks with no attacks or problems. Petey is still alive and well,
a happy and healthy glider. I still can't believe that we got him
through it. I want to stress that two things made the biggest impact
in saving Petey's life.
First, that we were attuned enough to our
glider to detect the strange quality in his cry when he first
started biting himself, rather than ignoring it as a spat. If
we'd missed that, he would have probably done enough damage the first night
to make it impossible for him to recover.
Second, we did whatever it took to care for
him - the rest of our lives stopped cold, and we spared no expense. He
was taken to the vet immediately and as often as necessary, I changed my
work schedule and/or took time off to be with him, and we were both willing
to miss almost all sleep to stay awake with him 24/7 for a long
stretch of time. I firmly believe that without both of
those things in place, Petey would not be around today.