Help with palliative care and meds dosing

[tanzanyte]

So my rather tubby, Bubsy gerbil has an internal tumor. I mentioned to two different vets practices that I was worried about her as the last few months she's moved around less. Both vets thought it was her weight and that we needed to let her run around in the play area without access to home for 20-30 minutes to keep her active. The gerbies usually have access in and out all day but Bubbles is more easily frightened and doesn't spend most of her time out there like her sister, Vanilla, does. We've been doing this and her weight still hasn't gone down.
In August her 2 front teeth broke which thankfully we caught early so she dropped a couple of grams and was on pain meds. They grew back straight (hurrah!) and she's been fine eating, although still not very active. This week we've noticed that she looks very tubby when standing on her hind legs, but her back is quite scrawny as you can feel her bones-not something we've ever really had with Bubbles. 

The other evening she looked awful and was hiding in a corner (not like her unless she's eating). We put a heat pack in and she sat on it and slept. I wasn't expecting her to make it through the night, and came down to monitor her every few hours.
She was a bit perkier in the morning, much to my surprise, however she still wasn't moving and didn't have her eyes fully open. We arranged to see the vet who has confirmed my suspicions of an internal tumor. Much as I'd love the magic wand that surgery can possibly bring, it is not what Bubbles would like as she's sociable, but not massively so. She doesn't like being prodded and poked and is easily frightened and this feels like it would be an awful experience for her. My daughter is also scared that she won't make it through the anaesthetic.
Bubbles also has an external tumor in her ear, so it really feels like she is on borrowed time. I am devastated as I thought they'd live longer than this as they aren't 3 yet. I also think she's started peeing more, just like her sister who has early kidney disease, because the corner where I found her hiding has been very wet lately and that isn't somewhere her sister goes. So it's probably affected her kidneys too.
In view of the possible kidney problems, we've been given paracetamol to put in her water. However I am concerned about this as last time I tried vitamin drops in their water they wouldn't touch it. I then put 2 bottles in and they didn't go near the other bottle. I will have no idea how much of it she will actually be ingesting either.
Does anyone know if I can give paracetamol to them directly and how much to give?
Is there anything else I can be doing to make her more comfortable?
Also how can we keep Vanilla happy when her sister is gone?

[betty]

Sorry to hear about a very poorly Bubsy/Bubbles - sounds like some serious bad luck for her.

I have never heard of vets recommending dissolvable myswlf - but anything in water for gerbils really won't be ingested enough through a water bottle - only if 'forced' or encouraged (like soaking bread in it, or cooking porridge in it) but often the dilution can be an issue here.

The best pain med would be cat metacam from your vet - it is quite thick and often gerbils LOVE the taste and will eat it on a sultana or other tasty foodstuff.

Depending on the severity (and how happy you are with her symptoms/behaviour) the alternative to pain management is of course a valid option here, and your vet should agree on this should you wish to progress that way.

Vanilla will be fine on her own if she gets plenty of enrichment and human contact, however if you wanted, you could consider a new friend for her - especially if a local animal rescue has an older single gerbil looking for a friend too.

[tanzanyte]

The vet didn't want to give metacam because it is well documented to damage the kidneys, especially when it's highly likely Bubbles kidneys are affected. However I had some metacam left and have used that as I'm not keen on putting things in the water. I saw a different vet and I'm not sure how much knowledge she had as she went off to check out the British small animal formulary. It does indeed say that rodents can have it as I've checked since.
We are really struggling to give Bubbles the metacam as she doesn't want to take it. We've tried in some fruit pouch/baby food etc and are also trying to give it to her but she starts wriggling pretty fas (she has never liked being turned over for checks). I'm not sure how much of it she is actually ingesting and whether it's helping.

Do you know of any quality of life table for gerbils? I've looked at the generic ones but it's hard to tell where she comes as she is still mobile, just nowhere near what she was, she is still eating and drinking as far as I can tell, and will still take treats, although she is picky about which ones. She isn't right, but its hard to know if she's in pain. I could tell with her teeth as she kept rubbing her mouth. This time I am clueless, only I don't want her suffering. I keep putting heat packs in old socks and she loves sitting on them, especially when her sister is out in the play area doing her own thing.

How do you go about introducing another gerbil? I heard that it was very difficult and have been loathed to try in case it ends badly. Is there a thread on here already about it?

[betty]

Hello again - and yes - Metacam is deemed safe for short term use in gerbils - and is often the best compromise. As far as I believe it only has long term effects and so short doses don't (as far as I have seem with my own gerbils) seem to shorten their estimated lifespan if seriously ill - and many gerbils have lived on a year or more after treatment for injuries. However, I don't know for sure of course and so I would always work closely with whatever a vet you trust says.

I haven't ever seen a quality of life table for a gerbil. and it really depends on what you yourself are happy with as quality of life. Some people work on the basis that keeping them alive for as long as possible is the best course of action, and other can make a decision based on their 'old life' being completely different to where they are now.

As for warmth, I think all gerbils like a bit of extra heat overnight in all but the warmest weather, and whenever I add a heat mat under their enclosures, sick or healthy, they always gravitate towards them. I always imagine them smiling when they find it all cosy!

There are also plenty of cases and examples on here in the behaviour section - just search for 'split intro' or 'split cage' and have a good read. You can always ask specific questions on a new thread if you prefer.

[Pim]

betty What heat mat do you use? I was looking into one for clover as he is alone and I feel like when he wakes up he isn't as warm anymore. 

[beachbumgerbils]

I am a veterinarian and while I mostly treat cats and dogs, I do see the occasional small mammal. The following advice is general. I cannot make specific recommendations without a physical exam.

Meloxicam (or any drug in the same category, including aspirin and ibuprofen) comes with the small potential risk of liver or kidney damage. The risk becomes higher when the animal has pre-existing liver or kidney disease. It also becomes higher if the animal is dehydrated. Meloxicam is probably the most commonly used pain medication in small mammals because we have the most information about its use in rodents. We don't have a lot of other great options for critters this small, especially without getting it specially compounded. Gabapentin is something else you could discuss with your veterinarian. It is used for nerve pain, does not cause organ damage, and at least in other species, the most common side effect is mild sedation. It also comes in a liquid form. I haven't used used it in gerbils, but have in other small mammals. I am not a fan of anything dissolved in water. Some things become ineffective very quickly when dissolved and you can't really know what dose they are getting.

I also am not aware of a quality of life table for gerbils. I suspect that is because rodents are programmed to be really good at hiding disease and pain. If they limp or cry or act sick, they get eaten in the wild. So disease is often very progressed by the time we recognize it. Bubbles will continue to try and act normal until the end. Closely monitor her food intake and activity. Regardless of the type of cancer, a large tumor in the abdomen can put pressure on the stomach and intestines and make her nauseous. Squeaking when you put gentle pressure on her belly is likely a sign of pain. Unfortunately, there isn't a right answer or a right time in these cases.

[betty]

Heat pads are the strip ones they sell for rats - very low heat and very safe as they sit on the outside/underside of the enclosure.

They are available in literally all sorts of sizes and are usually strips or squares. I aim to cover around a third of the bottom of the enclosure with one so they can get off it easily and the other end of the enclosure isn't affected by it at all. I also make sure it isn't under their food, water or wheel - or only nest.

If you search for prorep heat mat you will see the style I mean - as there are many suppliers who make and sell them.

[tanzanyte]

Thanks everyone. This is really helpful Beachbumgerbils - at least I have further options.
I managed to speak to my normal vet on Monday and she prescribed Gabapentin (it's good to know that another vet feels it's a good one to try and we're on the right track). My vet said she would never give gerbils anything via water as they just don't drink enough and you'd have no idea how much they were getting. I guess the vet I saw for the emergency apt didn't deal with rodents often.
We've been giving Bubs a minuscule dose twice a day all week and it seems to be going well. She is more lethargic but I know it knocked me out when I first started on it myself. Thankfully no squeaks of pain, although I don't want to prod her. She seems to absolutely flop on the heat pad, although I'm getting a bit worried because often I have to put the heat packs in the corner she likes to hide in, which means she doesn't always sleep with her sister unless it's night time. The heat strips that you mention, Betty, may be just the thing.
I have been making a hot water bottle to put behind their cage but I'm just not sure much of the heat is radiating through.

Thank you for the information regarding quality of life. I have reminded my daughter that Bubbles is on borrowed time, but because Bubbles has periods where she seems quite bright, it's hard to keep in mind that it doesn't mean she's better.
I've planned ahead and bought some little wooden boxes - quite impressed as they slot together so no glue or nasties that then get buried in the earth, and they have plenty of room to put bedding in. I feel so daft thinking like this, whilst trying not to cry, because it matters to me.
It will hopefully mean the cats or foxes will have a harder time. I'm hoping to get the kids to decorate it, but that may be too big an ask. We'll see. We already did a foot print so my daughter will have that to keep.

[beachbumgerbils]

You are very welcome! As a veterinarian, I can tell you that we get very little training in small mammals and exotics. A regular general practice vet might be excellent, but care and treatment of rodents is very different from cats and dogs. You really have to have a passion for the little critters to gain that extra knowledge. I'm glad that you were able to come up with a plan and that the gabapentin seems to be helping.

Thank you for caring about Bubbles so much. The worst thing about the little guys is the relatively short life span. Saying good bye is always hard.

Feel free to hit me up with any questions as things progress.

[betty]

Hey tanzanyte - how is the little one - is the medication still working out well?

[tanzanyte]

That’s so kind of you to check in. Unfortunately I had to take Bubbles to be put to sleep today. I’m devastated and feel like I maybe should have done more. She was managing for a week on the Gabapentin and then started pulling at her fur by her ear tumor and making the tumor bleed so we immediately went back on the metacam. She was fine with this and I’ve been giving her additional heat pads as although I bought an electric one I couldn’t find a thermostat. She fell from my legs whilst I was sat a couple of days ago but seemed ok. This morning we gave her her meds and she was fine. Then when I checked in on her after an online meeting, there was blood spatter everywhere. She looked so weak. I tried giving her a few different treats and water, but she refused to take anything. I sat with her for several hours, only I had to keep her sister away when she kept trying to clean the tumor and Bubbles would squeak and move away. That was when I noticed she was limping along and not putting any weight on her front paw. She was barely opening her eyes so I made the call to the vets this afternoon. Then she decided to eat a bit of a treat and have a drink. However she still wouldn’t really open her eyes. The vet offered to look and see if there was anything she could do but it felt like I’d be prolonging her suffering and she agreed that from what she’d seen it didn’t look good. I don’t know if I made it worse when she fell, maybe she broke her front leg? I don’t know if I should have separated the girls as I noticed Vanilla clean it once yesterday when I was changing heat pads. I think I will be wracked with guilt for some time.
I brought her home so Vanilla could see her and she cleaned her up and when she moved away then I took Bubbles out. I don’t know how long I should have left her there.
Now I don’t know how best to help Vanilla. I did look at the posts about intros but as she has kidney issues it would feel unfair introducing a baby, and neutered males are rare.

[beachbumgerbils]

Bubbles was an older gerbil and had a tumor that was probably horrible cancer. If she was scratching and pulling fur out, the tumor near her ear was bothering her. She would not have survived surgery. You gave her lots of TLC and took her to the veterinarian multiple times to make sure that you optimized her quality of life. You do not need to feel guilty at all. It's okay to be sad. It's normal to be sad. It sounds like Bubbles was a really lovely pet and will be missed. But don't be guilty. If she had broken her leg in the fall, there would have been squeaking and limping then. It's more likely that one of her tumors spread and starting affecting the nerves of her leg. Thank you for giving Bubbles a wonderful life.

If Vanilla is an older gerbil with health issues of her own, I don't know that I would put her through the possible stress of an introduction. She can still live a very happy life, just make sure to give her extra attention and environmental enrichment/toys.

[gdopmop]

So sad to hear about Bubbles, really thinking of you. It's always tricky to know when the time is right, isn't it, but it certainly sounds as if you've been a wonderful guardian and tried your best for Bubbles. All of our gerbils who've outlived their cage mate have done incredibly well without a new introduction. As Beachbumgerbils suggests, we ensure to give them masses of company, fuss and attention (and toys); ours live in the room that we're most often in. We find they tend to bond even deeper with us and don't demonstrate any signs of loneliness/depression. Best wishes to you and Vanilla.

[tanzanyte]

Thank you everyone. I'm sure I will be wondering if I left it too late and should have had her put to sleep sooner. Trying to do what is right for a pet, and also what is right for an autistic child is hard.
I'm sure we'll feel it for a while. I've lost my little shoulder mate and miss her antics more than I ever imagined. Vanilla seems quite miserable. I've tried changing half of her cage around, although she wouldn't let me take the tissue with blood away as she just kept grabbing it off me to put it back. I've left it for now and will try again when she's out in her play area. I've bought some new bits for her cage and the play area to add a bit of interest. I am spending lots of time with her, but she seems to be spending a lot of time in her little nest. She has piled it high with toilet paper that I've hidden in her play area to give her more to do. They are in the next room, there's a huge double doorway that has no doors so they can hear us and we can interact with them. However I've been making sure I'm in her play area so that she can come out and join me if she wants to. Hopefully time will help. Although any other ideas that anyone may have would be appreciated.

[betty]

You did what you felt was right at the time - and that is the best you can do.

I would personally just let her get on with being a bit grumpy for a while and gradually clean out the enclosure in bits. I would start by adding a new nest box with fresh bedding in it and see if she moves into that (then you can get rid of the old one completely). I find distraction works very well with gerbils, so offering them something new rather than taking something else away is usually my mantra. Then you know it is their choice - at least at first anyway while it doesn't really matter so much.

Sultanas - they are the way to any gerbil's heart.

Rustle around in her substrate just lightly until she surfaces and then give her a sultana with your hand (or half a sultana anyway - they are quite sugary). If she doesn't come, just leave the half sultana on the side. Then every day do the same - rustle the substrate and straighten a few things, but never actually go looking for her - then when she approaches - go sultana. It usually doesn't take long to get them to come out looking for you whenever you open the enlcosure (and you can call their name at this point and it will look like they are answering your call to anyone else watching (great show trick for kids).