bilateral ankle swelling in 4 week old gray

[winky2]

I have a 4 week old gray squirrel that was found surrounded by the neighborhood cats. She was plump and well hydrated, had two very tiny abrasions on the inside of her right thigh, bloody nasal discharge and blood in her urine. The blood in her urine and nose resolved the next day and she has been eating like a champ and gaining weight. I cleaned the wound on day 1 ant it was no longer visible on day 2. Yesterday (day 9) her lower limbs were very pink and today her skin tone is normal but both of her ankles are swollen. They don't seem tender but her range of motion is slightly decreased due to the swelling. She is housed with two other gray orphans and all are about the same age and weight (+/- 20 grams). She's been on Esbilac with heavy whipping cream and just opened her eyes yesterday. I have a cuttle bone in the cage for calcium but she hasn't started chewing on it yet. The cage is pretty safe and I haven't noticed her trying to climb although there is one tiny area with bars. Anyone have any clues? Isn't she too young for MBD? I have liquid clavamox I don't really think this is bacterial and I don't want to mess up her GI flora. I'm thinking about a NSAID but not really sure about that either. I feel like I should do something. I know they can crash really fast. She's eating fine and seems energetic. Any advise? Thanks!

[LynninIN]

Do you have a picture that you could post of the swelling?

[winky2]

Sorry, the digital camera is MIA.

[Mars]

I'm puzzled by this and the only suggestion I have is warm compresses. There are glands on the inside of her legs. Can you tell if they are swollen too or is it limited to just her ankles?

[LynninIN]

Oh good, Lynn's on here.
Even better, Mars is here.

Winky, Mars is a very experienced rehabber you are in the best hands.

[winky2]

I'm puzzled by this and the only suggestion I have is warm compresses. There are glands on the inside of her legs. Can you tell if they are swollen too or is it limited to just her ankles?

I just finished a 5 minute warm moist compress session and I decided to give .1 ml of clavamox because I think she is febrile. The swelling is slightly proximal to the joints and there is no redness, crepitus, or bruising. Sure wish I could find the camera.

[winky2]

Mars, No swollen glands that I can detect.

[LynninIN]

Where is the swelling in relation to the two small abrasions found on day one.

Have you checked the inguinal and lower abdomen nodes?

[winky2]

LynninIN,

The swelling is below the tiny abrasions observed on day 1 (which was only on one thigh).

[LynninIN]

How about skin temp differences between the front and back legs?

[winky2]

LynininIN,

Inguinal and abdominal nodes are not palpable.

[winky2]

LynninIN,

I would say her front and real legs are the same temp but her rear feet feel slightly warmer (maybe because they're fleshier). Her femoral pulses are strong.
If this were a dog or cat I would be thinking cellulitis or vasculitis.

[LynninIN]

LynininIN,

Inguinal and abdominal nodes are not palpable.
Good

[LynninIN]

LynninIN,

I would say her front and real legs are the same temp but her rear feet feel slightly warmer (maybe because they're fleshier). Her femoral pulses are strong.
If this were a dog or cat I would be thinking cellulitis or vasculitis.
I'm thinking cellulitis, probably from the cat bite. There could have been very superficial scratches on the left that weren't seen. Clavamox will cover this well but is very hard on a squirrel's GI tract. Watch for any GI distress and keep her really well hydrated. Pro-biotics would be a good addition.

You obviously have vet/medical training of some type, I think the little one is lucky to have you.

I'll be back in about 30 minutes.

[winky2]

LynninIN,

Thanks for the advise. I'll continue the clavamox, warm moist compresses and hope her fever and pain stays under control. Would you recommend fortiflora for squirrels?

I work for an animal hospital but my squirrel rescue work is against the rules so I run a very small scale underground railroad for the non-native squirrels brought in by folks that would rather not see them euthanized or attacked by cats.

I'll give you an update in a day or two.

[winky2]

Gammas Baby,

Thanks for your support. Hopefully I'll have good news soon.

[LynninIN]

No, I wouldn't use the fortiflora. Benebac would be a better. Mars most likely will have an even better choice to give you when she signs back on. She probably is busy with babies right now. Last year she had 40 squirrels plus other critters. :bowdown

Bless you for your squirrel underground. I've heard it's difficult to rehab non native squirrels in Oregon. We have a few members on the board from that area. Your full privileges should be approved by morning and I'll pm their board names to you.

Is she still on a heating pad? If not it would be a good idea to offer it to her. It will help with the heat loss from infection and dual as a compress in between the moist ones. Are you giving anything for pain or fever?

I'll check in tomorrow morning. I'm in EST.

[winky2]

LynninIN,

Yep, she's still on the heating pad. I haven't started pain meds yet, not sure what's safe for squirrels. Any thoughts? I'll get some Benebac started ASAP.

I don't know of anyone in Oregon who officially rehabs non-native squirrels in Oregon but there are plenty of non-native orphans this time of year. I have had good luck raising/releasing Eastern Fox babies and Eastern Grays. I've never even seen a native orphan.

Yikes! 40 babies. That's a full time job.

[LynninIN]

I never said officially. :D

Benebac needs to be given 2 hours before or after antibiotic.

[Mountain Mama]

This thread sounds like Grand Rounds at the hospital!

Winky you could add some yogurt to her formula for probiotic coverage. I use Stonyfield's vanilla for my babies with great success. No artificial sweeteners...just regular yogurt. They love the taste.

[LynninIN]

This thread sounds like Grand Rounds at the hospital!
:rotfl The question is do you agree with the diagnoses and plan of treatment?

FYI: List of approved pain meds were given to winky2 with appropriate precautions.

[Mars]

Well this is very well under control. :thumbsup Thank you LynninIN :bowdown

[winky2]

Update. She's still eating, no diarrhea and temp seems normal but the swelling is worse. It's more localized over the joints (medial ankles) and there is some obvious redness now. She's had her third dose of clavamox and is on pain meds as well. I'll update again tonight.

[Mountain Mama]

:rotfl The question is do you agree with the diagnoses and plan of treatment?

FYI: List of approved pain meds were given to winky2 with appropriate precautions.

I do concur.:D

But I am wondering if she may have somehow done something in the last couple of days to cause some trauma to her legs. That's the only thing I an think of that would account for bilateral swelling like that. I know you said she doesn't seem tender, though she does have some limited ROM. Any edema in her toes? Maybe she got her feet caught in/on something when she was moving around?

Seems like if it were bacterial you would be seeing improvement by now. :thinking

[4skwerlz]

Occam's razor says:

baby found surrounded by cats + puncture wounds on legs + swelling in legs = abscessed wounds

don't you think?

[Mountain Mama]

Occam's razor says:

baby found surrounded by cats + puncture wounds on legs + swelling in legs = abscessed wounds

don't you think?

You would see the swelling right at the puncture site and extending outward from there, so I would expect to see swelling at the thigh, rather than the ankles. But I didn't get the impression there were punctures, though, just abrasions. Did I miss something?

[4skwerlz]

Sorry, I don't mean to get in the way of the Great Medical Minds of TSB like you and Lynn.:D I just always figure with cats, it's always punctures, if you know what I mean...... And can't the swelling accumulate lower in the limbs? Or perhaps the lymphatic system in the legs was damaged? Just asking questions and trying to learn.

[Mountain Mama]

Sorry, I don't mean to get in the way of the Great Medical Minds of TSB like you and Lynn.:D I just always figure with cats, it's always punctures, if you know what I mean...... And can't the swelling accumulate lower in the limbs? Or perhaps the lymphatic system in the legs was damaged? Just asking questions and trying to learn.

Psh, yeah, I am a regular Hippocrates.:D

I'm just thinking with such a little fella, 4 weeks old, that a puncture would be readily visible. Swelling can accumulate in the lower limbs, but you may be thinking about dependent edema, where the fluid accumulates in whatever part of the body is lowest to the ground. In a baby that small, I wouldn't think she would be on her legs all of the time, but rather lying down. But if I were dependent edema, you would see swelling in her feet upwards. I can see where you are going with the lymphatic damage, but it would just be odd to see it bilaterally like this.

Winky, any chance she has had a flea or other insect bite? Do you see anything on the others?

[4skwerlz]

A picture would be worth a thousand words in this case.

[LynninIN]

Consider infection with Bartonella henselae, it's very difficult to treat once active. Ask the vets at the animal hospital about treatment in a "rabbit" ;).

[winky2]

Update for Sunday night. The swelling has stabilized! I expect it to be decreasing by morning if the clavamox is working. She's eating and taking her meds just fine. No diarrhea yet.

To answer some of the questions:

She was found by herself surrounded by cats but there were no puncture wounds and the tiny abrasion on her right thigh were immediately scrubbed with chlorhex and they were not even visible the next day. I figured her injuries were the result of the fall from the nest. It doesn't look like an abscess and she doesn't seem painful either. Her toes are not involved. I'll try to find the camera and get a picture for you all. Honestly, this really looks more like a disease of the joints today. I've been looking closely at her other joints and so far they look fine. As for Bartonella henselae, I hope not. She doesn't seem sick enough. I'll keep you posted.

[winky2]

Well, this little baby continues to eat, drink, and develop despite her illness. The swelling increased in her right ankle yesterday and it was starting to look like an abscess so we aspirated some fluid and found a thick white fibrous exudate (definitely not like pus). I wasn't able to get a smear because I'm having to do this at home. I talked to our most knowledgeable rodent doc and she said it sounds like classic Pasteurella which can start with fever, cellulitis then progress to abscess or arthritis of the hocks. So I switched her to Baytril and she's now getting metecam for pain. This morning the swelling is slightly reduced. I have had to separate her from the other two because it is communicable. I understand this can be a very tough bacteria to fight in rabbits but does anyone out there have any idea how well squirrels respond to treatment? I'll keep you posted on her progress.

[Mars]

YOu may be in for a fight. May I suggest adding some Nutriferon to her diet? It's a Shaklee product and will stimulate her natural production of interferon boasting her immune response.

[winky2]

Mars,

Where can I get Nutriferon? Is it available in health food stores or pet supply stores? I think she's finally starting to feel sick. She's eating less, lethargic, and her respiratory rate has increased.

[Mountain Mama]

I understand Pasteurella is very difficult to treat in squirrels. What do you have that has good beta lactamase coverage? In humans, we use Augmentin as a first line agent...it's amoxil plus clavulanic acid.

Please keep us updated.

[winky2]

Mountainmama,

Sorry, I can't answer that question because I have no idea what antibiotics have beta lactamase coverage. I'm not as smart as I think I am. I was told by one of our staff vets that Baytril is the way to go to treat Pasteurella and that the Clavamox won't touch it. I hope she's right.

[LynninIN]

Winky's baby gray has been on Clavamox which an amoxicillin/clavulanate combo for 5 days. I'm not sure why it wasn't covering Pasteurella. Sure hoping the Baytril works. I'll see if I can contact someone who may have some suggestions.

[Mountain Mama]

I guess I should slow down and read more carefully. I saw the Clavamox the other day but skipped over it tonight.

Clavamox should cover Pasteurella...it does in humans. Maybe add some clinda?

Lynn? Thoughts?

[LynninIN]

Maybe add some clinda?

Lynn? Thoughts?
In a human yes, in a squirrel with Pasterella :dono. Baytril is indicated for Pasteurella so hopefully it will work.

[4skwerlz]

Have you tried wet warm compresses on the area?

[winky2]

I have bee doing warm moist compresses for several days now.

[Loopy Squirrel]

Can't give rodents clindamycin. It is highly toxic to them and will kill them.

[winky2]

I started new thread under Life threatening section. Please see Pasteurella suspected. Thanks!