Emergency Treatment of Metabolic Bone Disease (MBD)

[Administration]

Emergency Treatment for Metabolic Bone Disease (updated 3-31-09)

Get calcium into the squirrel IMMEDIATELY, not later, not tomorrow, NOW. Delaying treatment can cause death or permanent paralysis.

You will need:

--Tums or calcium pills (any kind)
--a syringe, eyedropper, or spoon

Crush one Tums or calcium pill and add a little water or fruit juice. Use the syringe, eyedropper, or spoon to force-feed the mixture, a little at a time, until it is all gone. Feed a total of 600-800 mg of calcium, and spread it out through the day and night to keep his blood calcium levels as steady as possible.

If the squirrel is having seizures, weakness, or paralysis, the symptoms will usually improve within a few hours, but this does not mean the squirrel is cured. It will take many months to rebuild the calcium in the bones.

Long-Term Treatment for MBD

The next step to curing MBD is to fix the diet.

1. Remove ALL seeds, nuts, corn, and treats.

2. Follow the Healthy Diet For Pet Squirrels, which can be found at the top of the “Squirrel Nutrition” forum. (http://thesquirrelboard.com/forums/s...ad.php?t=16093 (http://thesquirrelboard.com/forums/showthread.php?t=16093)) Your squirrel MUST eat rodent block or squirrel blocks every day. If your squirrel doesn't like rodent blocks, you can try crushing them up with peanut butter or avocado temporarily. You can also make a tastier version of squirrel blocks using the recipe at the top of the Squirrel Nutrition forum.

3. In addition to the Healthy Diet, you will need to continue giving extra calcium every day for several weeks. Either use the syringe/eyedropper or you can try putting the calcium on a small piece of fruit.

Week 1: calcium = 500 mg per day
Week 2: calcium = 250 mg per day
Weeks 3-8: calcium = 100 mg per day

The cause of the acute symptoms—weakness, lethargy, seizures, paralysis—is a drop in blood calcium levels. If these symptoms return at any time, you will need to give another emergency dose of calcium.

More Tips
MBD causes brittle bones that break easily. Try to keep your squirrel away from high places, where he might jump and break a bone. Also, if he is in a tall cage, either place him in a smaller cage, or pad the bottom very well.

Heat is very soothing for a squirrel with MBD. A heating pad turned to low and placed so they cannot chew the pad or cord, or a rice buddy (a sock filled with dry rice/beans and microwaved for about 20 seconds) will work.

(http://thesquirrelboard.com/forums/editpost.php?do=editpost&p=403417)

[4skwerlz]

One final thought:

Just wondering if the ramp-down of calcium isn't too quick. Seems like in practice we end up with reducing it by around 50 mg per week.

Any input from anyone else on that?

[island rehabber]

Personally I would ramp down more slowly......by 50ng/week sounds right, as you suggested. :thumbsup

[4skwerlz]

How about this:



Calcium Dosage:

Week 1: 500 mg/day
Week 2: Reduce daily dosage by 50 mg
Week 3: Reduce daily dosage by another 50 mg
Etc.

If symptoms return or worsen at any time, you should give an emergency dose of 100 mg and increase the daily dosage to the previous level. Wait at least 1 week and then try a 50-mg reduction again.
I know you want this "done and stuck" (me too), but maybe we should wait for more comments. It's important I think that we have consensus on this treatment; that it's something we can all recommend confidently.

[island rehabber]

Agreed! That's why I haven't closed the thread the way we usually do. We are open and welcoming comments.

[UDoWhat]

I am wondering too. I used this protocol for 2 squirrels I admitted last year around this time. They were pretty bad off but responded to this regimen of calcium treatment. In a matter of a few days they both began to move about ... slowly without crying in pain in the middle of week 1. Week 2 was still slow movements but less pain. My notes indicate that it wasn't until week 4 that both squirrels began to try to climb the sides of their small ( meaning not tall) cage. The first 3 weeks I noted that they did show signs of progress but still also showed signs of pain. All that being said, I wonder now if I had reduced their calc. intake more slowly as you are suggesting especially from week 1 to week 2, if that might have been better for them. Rather than to reduce the calc intake by 50% from week 1 to week 2. As I am looking at my notes, the ramp down so quickly may have been a bit much from week 1 to week 2, in particular so early in the treatment. I did note that my Vet had me give these 2 squirrels Buprenex for pain 2x per day in the first week. I am inclined to think the slower "ramp down" may be better.
As a side note, I kept these 2 squirrels all winter and released them in early July. I had them a total of 10 months. They were READY for release and I still see them from time to time.
If/when I get any more MBD squirrels, I think I will try the slower ramp down and see if/how the results compare to the original MBD treatment.
Still thinking...

Marty

[muffinsquirrel]

How about this:



I know you want this "done and stuck" (me too), but maybe we should wait for more comments. It's important I think that we have consensus on this treatment; that it's something we can all recommend confidently.

I would trust you both, and a few others on TSB, with my life, and even more importantly, with my squirrel's lives. No one person can possibly know it all. That is why TSB is so great - it is the combination of many years of experience, researching, and common sense from many different people. If something comes up that I am knowledgeable about, I post my thoughts. Otherwise I read and learn. Ya'll are the experts here, and you are doing a fine job. What you decide on suits me fine.

Judy

[astra]

reading posts and getting a bit confused, so wanted to make sure:

ramping down by 50mg per week, thus the treatment will be extended to more weeks, right?
not ramping down 50mg or so per day during each week (e.g., week 1 : Mon- 500 Tue - 450 - Wed - 400 etc).

[4skwerlz]

reading posts and getting a bit confused, so wanted to make sure:

ramping down by 50mg per week, thus the treatment will be extended to more weeks, right?
not ramping down 50mg or so per day during each week (e.g., week 1 : Mon- 500 Tue - 450 - Wed - 400 etc).

Astra, if you're confused, obviously it needs more work... Yes, reducing by 50 per week, and yes the treatment should last longer. This seems to be the consensus among rehabbers, vets, that it takes many months to cure.

I get a lot of these calls. Folks with pre-MBD or MBD. They either find Henry's before TSB these days, or they see the handy phone number and prefer to talk to someone. Starting with the high dose (500 or even 600 mg) and then ramping down slowly, ramping back up if symptoms return, seems to be what works. Plus fixing the diet of course; that is crucial. In most cases, recovery is uneventful.

Theoretically, a squirrel with mild MBD could have a lower starting dose. Not sure how we'd determine that though.

[UDoWhat]

reading posts and getting a bit confused, so wanted to make sure:

ramping down by 50mg per week, thus the treatment will be extended to more weeks, right?
not ramping down 50mg or so per day during each week (e.g., week 1 : Mon- 500 Tue - 450 - Wed - 400 etc).

I think the decrease would be by 50mg of calc per week. Not per day... or so this is how I understand it. It makes sense to have less of a drop off between week 1 and week 2. As I said, I used this protocol, as written, last year and I did find it to be successful. But I really have nothing even close to compare it to with other cases I have worked with. The earlier MBD cases in "rehab land" were not specific in how much calcium to use and most conventional wisdom and treatment regimen at the time stated that any increased calcium intake should be continued for at least as long as the calcium deficiency had occurred. (What???) How could you even know. I would try to figure out how old the squirrel was, find out when it had been weened, and then estimate a "calcium deficiency" time frame. (It is a wonder any of these squirrels lived at all... BTW, most sadly did not.) I believe now that the high mortality rate was due to the lower intake in mg of calcium in the first few days and weeks of treatment. Back then I was told to use Rugby's and later I was told to use 1/8 of a 500 mg Tums. Finally, I did some research and found TSB protocol and some other's advice on other products to use.
Sorry, I got off message here... I believe the MBD treatment , as written, works well and has saved many squirrels, not just mine. I am just wondering if it could use just a little adjustment in the calcium drop off levels, especially in the early weeks. I really don't know for sure. Just a question. :dono

Marty

[Pierre]

I am wondering too. I used this protocol for 2 squirrels I admitted last year around this time. They were pretty bad off but responded to this regimen of calcium treatment. In a matter of a few days they both began to move about ... slowly without crying in pain in the middle of week 1. Week 2 was still slow movements but less pain. My notes indicate that it wasn't until week 4 that both squirrels began to try to climb the sides of their small ( meaning not tall) cage. The first 3 weeks I noted that they did show signs of progress but still also showed signs of pain. All that being said, I wonder now if I had reduced their calc. intake more slowly as you are suggesting especially from week 1 to week 2, if that might have been better for them. Rather than to reduce the calc intake by 50% from week 1 to week 2. As I am looking at my notes, the ramp down so quickly may have been a bit much from week 1 to week 2, in particular so early in the treatment. I did note that my Vet had me give these 2 squirrels Buprenex for pain 2x per day in the first week. I am inclined to think the slower "ramp down" may be better.
As a side note, I kept these 2 squirrels all winter and released them in early July. I had them a total of 10 months. They were READY for release and I still see them from time to time.
If/when I get any more MBD squirrels, I think I will try the slower ramp down and see if/how the results compare to the original MBD treatment.
Still thinking...

Marty

:thankyou This is great information. It would be great if all the people out there with MBD sqs added their experiences to make sure this sticky is as complete and updated as possible. All info is good! Come on, peeps, ah, er... squeeps!

:thumbsup

[Pierre]

Theoretically, a squirrel with mild MBD could have a lower starting dose. Not sure how we'd determine that though.

This is a good thought. Perhaps we could find out some ranges of how much Ca a rodent/rat can absorb at any one time. In humans, for instance, we can only absorb so much cholesterol in one sitting.

I agree to exceed that amount in the emergency setting for mbd, but if a squirrel is debilitated overall and has any kidney issues, they will have trouble excreting the excess Ca and could have sequelae over time. Something to ponder at any rate.

[4skwerlz]

This is a good thought. Perhaps we could find out some ranges of how much Ca a rodent/rat can absorb at any one time. In humans, for instance, we can only absorb so much cholesterol in one sitting.

The amount of calcium that can be absorbed is partly dependent on how much needs to be absorbed. For example, in a healthy animal with normal bones and eating a nutritionally complete diet, if you gave them a Tums, one would expect them to excrete most of it, because their body doesn't need it. The body takes what it wants and excretes the rest in the urine and feces.

In practice, if you see white poops or the pee drying with a white film, that would definitely indicate the squirrel is not absorbing all the calcium being given.

[UDoWhat]

This is a good thought. Perhaps we could find out some ranges of how much Ca a rodent/rat can absorb at any one time. In humans, for instance, we can only absorb so much cholesterol in one sitting.

I agree to exceed that amount in the emergency setting for mbd, but if a squirrel is debilitated overall and has any kidney issues, they will have trouble excreting the excess Ca and could have sequelae over time. Something to ponder at any rate.

:goodpost

On a side thought;
I do keep going back and forth in my thinking on this. Too much Ca, not enough Ca, how long to treat, etc. I was also thinking we don't have enough info to really know BUT... there have been many, many cases of squirrels with suspected MBD that have followed TSB's MBD Emergency Treatment , and many years later are still around to tell their story. I know we don't have a lot of documented medical studies, but the cases of suspected MBD that have followed the treatment and the subsequent improved conditions of these squirrels, has to mean or even "loosely document" something. I know we have to be careful here with any claims, however. Still thinking... :thinking

Marty

[4skwerlz]

:goodpost

On a side thought;
I do keep going back and forth in my thinking on this. Too much Ca, not enough Ca, how long to treat, etc. I was also thinking we don't have enough info to really know BUT... there have been many, many cases of squirrels with suspected MBD that have followed TSB's MBD Emergency Treatment , and many years later are still around to tell their story. I know we don't have a lot of documented medical studies, but the cases of suspected MBD that have followed the treatment and the subsequent improved conditions of these squirrels, has to mean or even "loosely document" something. I know we have to be careful here with any claims, however. Still thinking... :thinking

Marty
Agree, we're in no position to make any claims. Still.... I don't think we should dismiss or discount the collective experience here on TSB. Though not conclusive, these kinds of numbers over time can be suggestive.

You know, I'm trying to think of the last squirrel that died of MBD here on TSB (I think there was a flyer a little while back), and the one before that...and I'm having a little trouble remembering. Point being, when I first came to TSB years ago, squirrels were dropping like flies from MBD. Seemed like every week, down would go another squirrel, and the death rate was terrible. That's what first got me interested in squirrel nutrition! I wish I had time to collect all that data over the 4-5 years or so, and really chart it, but I have a pretty strong impression that the overall incidence of MBD is slightly down, that cases are being caught much earlier (this is hugely important), and that the response to treatment is better; i.e., death seems to be the exception rather than the rule.

So, yeah, no claims. But something seems to be working.... :)

Other old-timers might remember differently; as I said, it's just an impression.

[Pierre]

The amount of calcium that can be absorbed is partly dependent on how much needs to be absorbed.

Absolutely. In a perfect metabolic state. There are always upper limits of what is possible too.

[Pierre]

:goodpost

On a side thought;
I do keep going back and forth in my thinking on this. Too much Ca, not enough Ca, how long to treat, etc. I was also thinking we don't have enough info to really know BUT... there have been many, many cases of squirrels with suspected MBD that have followed TSB's MBD Emergency Treatment , and many years later are still around to tell their story. I know we don't have a lot of documented medical studies, but the cases of suspected MBD that have followed the treatment and the subsequent improved conditions of these squirrels, has to mean or even "loosely document" something. I know we have to be careful here with any claims, however. Still thinking... :thinking

Marty

:goodpost Absolutely here too! Good points.

[astra]

The amount of calcium that can be absorbed is partly dependent on how much needs to be absorbed. For example, in a healthy animal with normal bones and eating a nutritionally complete diet, if you gave them a Tums, one would expect them to excrete most of it, because their body doesn't need it. The body takes what it wants and excretes the rest in the urine and feces.

In practice, if you see white poops or the pee drying with a white film, that would definitely indicate the squirrel is not absorbing all the calcium being given.
tend to agree overall; however, if this could always be the case (our body getting rid of the excess amount of minerals/vitamins), there would not be such thing as overdose and tosicosis. Unfortunately, our bodies often end up building up and accumulating excesses, or not processing them correctly to begin with - something to keep in mind as much as possible.

However, I do not think that during Emergency MBD treatment there can happen any serious overdose of Cal - although, with individual tolerance and sensitivity various cases may take place - overall, Emergency MBD treatment does not seem to pose a risk of Cal overdose due to it rather limited time span.
It's the following diet etc might need more attention in terms of balanced amount of minerals and vitamins to avoid possible overdose and/or toxicosis:dono :thinking

[Pierre]

tend to agree overall; however, if this could always be the case (our body getting rid of the excess amount of minerals/vitamins), there would not be such thing as overdose and tosicosis. Unfortunately, our bodies often end up building up and accumulating excesses, or not processing them correctly to begin with - something to keep in mind as much as possible.

However, I do not think that during Emergency MBD treatment there can happen any serious overdose of Cal - although, with individual tolerance and sensitivity various cases may take place - overall, Emergency MBD treatment does not seem to pose a risk of Cal overdose due to it rather limited time span.
It's the following diet etc might need more attention in terms of balanced amount of minerals and vitamins to avoid possible overdose and/or toxicosis:dono :thinking

:goodpost Agreed!

[4skwerlz]

tend to agree overall; however, if this could always be the case (our body getting rid of the excess amount of minerals/vitamins), there would not be such thing as overdose and tosicosis.

To be clear, I was only talking about calcium here. Certain other vitamins/minerals are not excreted efficiently and can and do accumulate in the body.

[momma2boo]

Based on the original post in this thread peanut butter, although high in phosphorous, is recommended to use to mix the rodent block with for a squirrel with MBD or recently over MBD.

Aren't peanuts a no-no for a captive/NR squirrel? Therefore wouldn't peanut butter be a no-no for a squirrel with or just over MBD. Please let me know so I can pass along correct information.

[island rehabber]

I'm thinking the peanut butter can be left out, as well....I would only use it to give a squirrel meds and then only when all else fails.

[Pierre]

To be clear, I was only talking about calcium here. Certain other vitamins/minerals are not excreted efficiently and can and do accumulate in the body.

Calcium is not always excreted efficiently either. High serum blood levels [hypercalcemia] do occur. These levels have not been documented to come from calcium food consumption, but only from supplements. Age and kidney status decrease efficiency also.

My calcium RDA [for my age and sex] is 1,000 mg/day with an upper limit of 2,500mg.

Mild hypercalcemia may be without symptoms or may result in loss of appetite, nausea, vomiting, constipation, abdominal pain, thirst, and frequent urination. More severe hypercalcemia may result in confusion, delirium, coma, and if not treated, death.

I agree with Astra in that the chance of an untoward event during the emergency treatment period is very slim, however the following diet plan is important to keep the Ca in a proper range.

[4skwerlz]

The usual method has been to take a tbsp of peanut butter, mix the calcium powder in, and roll it into 5 little balls for handy dosing. I think that's around 5 mg of phosphorus per ball. IDK, most foods have some phos in them. :dono

The PB has worked very well but I usually tell folks to use whatever their squirrel will readily eat, since the main thing is to get the doses in. Yogurt is good too. Avocado. Crushed pecans. Sometimes fruit juice.

We could certainly expand the list of ideas...