Emergency and Long-Term Treatment of Metabolic Bone Disease (MBD)

[island rehabber]

I'm putting this up for comments. Please feel free to suggest changes. I will simply moderate the discussion. If we can reach consensus on the treatment, then it can be posted again as a sticky. However, there will be no one's name on it, and it should be understood that this treatment is a result of the collective experience of TSB in treating hundreds of MBD squirrels over the years.

Also, it has been proposed that a disclaimer should be placed at the top to the effect that: "The treatment below has been used successfully to treat squirrels with metabolic bone disease, however, it is not intended to substitute for medical advice from a veterinarian." Comments welcome on that point, as well.

Below is the current treatment:
********

Emergency Treatment for MBD

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

You will need:
• Tums, rolaids, or calcium supplement (any kind)
• a syringe or spoon

Crush one pill and add a little water or fruit juice to make a paste. Use the syringe or spoon to force-feed the mixture, a little at a time, until it is all gone. The first day, give a total of 500 mg of calcium per 1 pound bodyweight. Divide this amount into 6-8 doses throughout the day/night to maintain blood calcium levels.

Important!

1. Any kind of calcium pill is okay for the initial dose. But you must use PLAIN calcium pills (without Vit D) from then on.

2. Try to give many small doses of calcium throughout the day/night to keep blood calcium levels as steady as possible.

3. If seizures or paralysis worsen or return, give another emergency dose, then seek help from a veterinarian, rehabber, or from The Squirrel Board, as relapses can be very serious.

The acute symptoms (weakness, lethargy, seizures, paralysis) 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. (See the "Long-Term Treatment for MBD.”)

More Tips

MBD causes brittle bones that break easily. Try to keep your squirrel confined to a small cage and away from high places, where he might jump and break a bone.

Heat is very soothing for an animal 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.


Long-Term Treatment for Metabolic Bone Disease (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 on the Henry’s Healthy Pets website (www.henryspets.com).

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.

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

Calcium Dosage (for a 1-pound squirrel):

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

If acute symptoms—weakness, lethargy, seizures, paralysis—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 confined to a small cage and away from high places, where he might jump and break a bone.

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.

[Milo's Mom]

I only have one question...listing Henry's website for the Healthy Diet...is this in any way opening Leigh or Henry's up for "issues"?

[momma2boo]

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.

What about mixing it with a little organic babyfood fruit or vegetable instead of peanut butter since peanuts are high in phosphorous? Especially if the squirrel has had MBD.

[SammysMom]

I am just going to comment that the need for this thread change makes me sick! Good grief these fools really should direct their time and energy to helping the "G.D." squirrels, NOT hassling those who are giving their whole life to helping not only squirrels, but people like me who didn't know what the h*ll I was doing and would have killed my poor Sammy without the guidance so readily shared here.
Okay..carry on here, but know that the few spoiling it for the many is VERY sad fact of life that has no place here.

[stepnstone]

I am just going to comment that the need for this thread change makes me sick! Good grief these fools really should direct their time and energy to helping the "G.D." squirrels, NOT hassling those who are giving their whole life to helping not only squirrels, but people like me who didn't know what the h*ll I was doing and would have killed my poor Sammy without the guidance so readily shared here.
Okay..carry on here, but know that the few spoiling it for the many is VERY sad fact of life that has no place here.

[mpetys]

[QUOTE=island rehabber]
I'm putting this up for comments. Please feel free to suggest changes. I will simply moderate the discussion. If we can reach consensus on the treatment, then it can be posted again as a sticky. However, there will be no one's name on it, and it should be understood that this treatment is a result of the collective experience of TSB in treating hundreds of MBD squirrels over the years.

Also, it has been proposed that a disclaimer should be placed at the top to the effect that: "The treatment below has been used successfully to treat squirrels with metabolic bone disease, however, it is not intended to substitute for medical advice from a veterinarian." Comments welcome on that point, as well.[FONT=Comic Sans MS][COLOR=DarkGreen]

I agree with both points. I think it is a good idea to come up with the TSB information as a community effort, that belongs to the community. There are those here who have so much "hands on" knowledge who have much to offer but then there are those members who may have only dealt with one case of MBD (or any other ailment), that may have something important to add that may be overlooked by the others. And then, there are those like me, who have no experience with MBD, other than what I have read here on TSB, that may yet still be able to offer suggestions as to how something reads, how easy the information is to understand etc.

As for the disclaimer, I think that is a great idea. I think that disclaimer should be at the top of the Emergency and Non-emergency help needed sections as well as something that new members, when they first register, must read and click on something to indicate that they have read it and understand.

[island rehabber]

All good points, above - let's see what some others have to say and we'll go from there.

As far as disclaimers, the harsh cold reality of TSB and the internet in general is that "anyone can claim anything" on the www. Added to that is the fact that wildlife rehabilitation is a young, untried field (basically started in the mid-1970's) and methods are not set in stone. Virtually every active member here has probably been guilty of "giving veterinary advice without a veterinarian's license", for God's sakes, even when we tell someone to hydrate a baby with Pedialyte. It's when someone wants to do evil to someone else that these things get twisted into ugliness -- and of course, it's the animals who suffer in the end.

Keep the comments flowing, folks! We want to have the best of TSB brain power in this thread.

[UDoWhat]

Some way, some how, it should to be mentioned that MBD squirrels need to be given some kind of softened or crushed rodent block during this extended MBD treatment to protect the squirre'ls jaw bones. It is not advised to give MBD cases hard foods that might break fragile jaw bones or cause the squirrel pain while trying to eat block of any kind. Many MD rehabilitators crush block with apple sauce or other baby foods and feed from a shallow bowl while the squirrel gains strength and bone mass. I don't know how you might want to address this issue.

Marty

[UDoWhat]

Hey Marty. Do you have any more info on this? Of course in theory it sounds reasonable, but in all the years I've been involved with MBD squirrels I have never heard of a broken jaw from eating hard foods. This would be important information to have...

Sorry, I only have third hand info. Another rehabilitator's Vet advised her to soften the food to avoid any hard food (block) or nuts that might cause the squirrel she was working with any pain or cause fragile jaw bones to fracture.. I asked her what the Vet's theory was behind this she said it might cause pain or fracture and could cause the squirrel to associate this pain with the block too . A little far fetched but could be... I suppose. This advice was given many years ago(5-6 years, at least). I too had never heard of this but since that time I don't offer solid block for the first 3 weeks of treatment. I break up the block and add it to a little applesauce or avocado, or some baby foods. Surprisingly, I have not had any trouble getting most squirrels to eat the "gruel". By week 5-6 I offer block.
Leigh, I really don't know how valid a point this is but if the squirrel's bones hurt and are fragile I guess it is worth at least being cautious and considering that advice. (??) Don't mean to throw us off course, just thought it needed to at least be mentioned. I too have worked with many MBD's mostly because many other MD rehabilitators will not. They feel that if they have MBD they are NR. As I said just a thought. I wonder what others think. My Vet just said (years ago) when I asked her opinion, "I guess"... could be.

[UDoWhat]

No problema. Like I said, it's logical. I think it makes a difference whether they're using HHBs or regular rodent block, which are hard as rocks. Then add in the fact that they probably won't eat regular rodent blocks plain anyhow and it sounds reasonable.

There's already a sentence in the long-term treatment that says:
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

How about if we change it to:
Your squirrel MUST eat rodent block or squirrel blocks every day. If you choose to feed commercial rodent blocks, you should crush them up with peanut butter, yogurt, fruit juice, avocado, etc., to make them easier to chew and improve the taste.

Something like that?

Thoughts?

I think that covers all the bases. Addresses the taste issue and the easier to eat issue, too. I'm thinking this sticky is close to getting "stuck" soon.

Marty

[Karen4kids]

what are people's experiences with Calcium citrate?

I made some block with calcium citrate and I think it may not be good for them. I thought calcium citrate sounded like some harmless form of calcium with 'citrate' sounds fruity and wholesome, like citrus fruits, but that is apparently not the case. Their body may not recognize Calcium citrate, it can produce an immune reaction in people in high doses and it's very hard to get the dosage right for tiny squirrels.

I think this would be a good thing to know, maybe have a thread about because calcium citrate is EVERYWHERE now, in the drug stores.

[UDoWhat]

I think this is really looking good and covers so many bases. I am looking at a paragraph that I found so informative and useful that we might want to add. I am going to work on this paragraph and try to submit it for others to look at and see if it would be useful to insert in this sticky. I will be gone and not be able to post it until Wed. of this week. If this is ready to "stick", of course, do not hold it up. I will work on this info to make it less specific to a recent case of MBD . MBD is such a terrible disease. I am so glad we are concentrating our efforts together here.

Marty

[UDoWhat]

I'm also wondering if instead of "confining to a small cage," which may not be practical, or even desirable long-term, we should suggest padding the bottom of the cage?

Also, I think I will move the part about the white feces/urine up to the paragraph about adjusting the Baseline Protocol. It is usually during this first week that ca dosage may be ramped up (for example, trying to clear up remaining paralysis), then if the white feces/urine is seen, it indicates one should ramp back down because more ca is being given than can be absorbed. In other words, it sometimes takes a few days to a week to arrive at the Baseline Protocol: not too much, not too little.

Thanks for the input.

I had not thought of that on the cage size. I was really just thinking a short time in a smaller cage but as written it doesn't say that and it might make someone think that for the entire treatment period a squirrel should be confined to a small cage. We really do not want or mean that. I think it would be more practical to suggest padding the bottom of the cage versus buying a smaller appropriate cage. Padding can be done quickly and easily and right away.
I want to check the old wording on the Baseline Protocol. I don't want anyone to misinterpret that" baseline" to mean they should stay at that Ca # and not continue to ramp down over the weeks of treatment . I don't think that is the case. I just want to check the wording. Will post later on this.

Marty

[UDoWhat]

I saw this explanation of MBD and what we are trying to do with the calcium protocol and I was wondering if we might be able to use all or part of this excerpt. Even at the bottom or end of the Long Term treatment passage. I don't want a panicked first time squirrel owner to have to wade through a bunch of words and get discouraged but the info is important and helps people to understand what and WHY we are doing with the treatment. A member with a first time MBD squirrel might not read this right away buy when things "calm down" they will re-read the info and find it helpful. I know I did. I just thought it was well written and easily understood.
I did not write this (I wish I had). I have re-written it some to take out personal references. So, needed, not needed, good, bad, in, out??
WHAT DOES ANYONE ELSE THINK
Passage to consider:
The MBD treatment is a "standardized" treatment that will get most cases on the road to recovery. But in fact, every case is different and the treatment is best customized to each squirrel. Severe cases sometimes need more aggressive treatment. There is a limit to how much calcium the body can absorb at one time, so calcium given more often is the key with severe cases not increasing the mg of calcium.

By giving high doses of calcium (as per the treatment protocol) we are artificially maintaining blood calcium levels by giving calcium orally, because the squirrel’s bones no longer contain enough calcium to maintain blood calcium levels normally from the diet and from the normal processes of bone building and absorption. Typically, once calcium is given, within minutes to hours, the squirrel "bounces back" and acts normal or almost normal. As long as you are still seeing symptoms such as seizures, loss of appetite, lethargy, paralysis, the squirrel’s blood calcium levels are still too low. And as long as blood calcium levels are too low, the body will continue to try to pull the remaining calcium from bones, which means MBD is actually getting worse. So stabilizing blood calcium levels is the critical first step before you can even begin the process of rebuilding bone, i.e., actually curing the MBD, which is the part that takes a long time. Stabilizing the blood calcium levels can and must be done quickly. In severe cases, calcium may be needed more often throughout the day and evening. For example every 2 hours.

[UDoWhat]

I think the info could go under the Long -Term- More tips section.???????????????

[island rehabber]

The MBD treatment is a "standardized" treatment that will get most cases on the road to recovery. But in fact, every case is different and the treatment is best customized to each squirrel. Severe cases sometimes need more aggressive treatment.There is a limit to how much calcium the body can absorb at one time, so calcium given more often is the key with severe cases not increasing the mg of calcium.

By giving high doses of calcium (as per the treatment protocol) we are artificially maintaining blood calcium levels by giving calcium orally, because the squirrel’s bones no longer contain enough calcium to maintain blood calcium levels normally from the diet and from the normal processes of bone building and absorption. Typically, once calcium is given, within minutes to hours, the squirrel "bounces back" and acts normal or almost normal. As long as you are still seeing symptoms such as seizures, loss of appetite, lethargy, paralysis, the squirrel’s blood calcium levels are still too low. And as long as blood calcium levels are too low, the body will continue to try to pull the remaining calcium from bones, which means MBD is actually getting worse. So stabilizing blood calcium levels is the critical first step before you can even begin the process of rebuilding bone, i.e., actually curing the MBD, which is the part that takes a long time. Stabilizing the blood calcium levels can and must be done quickly. In severe cases, calcium may be needed more often throughout the day and evening. For example every 2 hours.

I like the above paragraph for exactly the reason you mentioned: it sums up the situation and spells it out clearly for the first-time squirrel person facing a case of MBD. It reiterates that although you may see "some" improvement, the squirrel is still at risk when you see ANY of those symptoms and its blood calcium levels are still too low. (People do want an overnight fix, and hate to medicate their squirrels if they feel "it's better now".) This is a good paragraph IMHO.

[UDoWhat]

Exactly, when I read this the other night it all seemed so clear. I have worked with these squirrels before so I get it, so to speak but this explanation just "popped out" at me. I think it really pulls it all together. Even if the case is not as severe it explains what is happening and Why we are doing the Emerg. treatment and the Long -term treatment and the importance of the protocol.

I would like to see it included. I also think it helps us explain the protocols as we coach others needing help.

Marty

[UDoWhat]

I can try to incorporate that info into the treatment if you like. Maybe at the bottom, as you suggested.

I think it would be extremely important info to include, IMO. This disease is so mean and nasty , I think any and all info we can provide is a plus. If IR and all others agree, let's do this.

[mpetys]

I saw this explanation of MBD and what we are trying to do with the calcium protocol and I was wondering if we might be able to use all or part of this excerpt. Even at the bottom or end of the Long Term treatment passage. I don't want a panicked first time squirrel owner to have to wade through a bunch of words and get discouraged but the info is important and helps people to understand what and WHY we are doing with the treatment. A member with a first time MBD squirrel might not read this right away buy when things "calm down" they will re-read the info and find it helpful. I know I did. I just thought it was well written and easily understood.
I did not write this (I wish I had). I have re-written it some to take out personal references. So, needed, not needed, good, bad, in, out??
WHAT DOES ANYONE ELSE THINK
Passage to consider:
The MBD treatment is a "standardized" treatment that will get most cases on the road to recovery. But in fact, every case is different and the treatment is best customized to each squirrel. Severe cases sometimes need more aggressive treatment. There is a limit to how much calcium the body can absorb at one time, so calcium given more often is the key with severe cases not increasing the mg of calcium.

By giving high doses of calcium (as per the treatment protocol) we are artificially maintaining blood calcium levels by giving calcium orally, because the squirrel’s bones no longer contain enough calcium to maintain blood calcium levels normally from the diet and from the normal processes of bone building and absorption. Typically, once calcium is given, within minutes to hours, the squirrel "bounces back" and acts normal or almost normal. As long as you are still seeing symptoms such as seizures, loss of appetite, lethargy, paralysis, the squirrel’s blood calcium levels are still too low. And as long as blood calcium levels are too low, the body will continue to try to pull the remaining calcium from bones, which means MBD is actually getting worse. So stabilizing blood calcium levels is the critical first step before you can even begin the process of rebuilding bone, i.e., actually curing the MBD, which is the part that takes a long time. Stabilizing the blood calcium levels can and must be done quickly. In severe cases, calcium may be needed more often throughout the day and evening. For example every 2 hours.

As someone who has never dealt with MBD, I found this very clear and concise in explaining just how MBD works to debilitate and eventually kill the squirrel if immediate intervention is not taken right away and followed through with the long term treatment.

I am wondering it it shouldn't be at the top to make sure people fully understand what they are up against and so that they don't stop with the immediate treatment when they have improvement. They may never read all the way to the bottom or come back to read it. If it is going to be at the bottom, then maybe something at the top imploring people to make sure they read the full explanation at the bottom of how MBD affects the squirrel and why following the COMPLETE MBD protocol is so important.

[UDoWhat]

Okay, will do. Will maybe include an asterisk to direct folks to the info as Mpetys suggested.

Great, I am really glad this info is being included.

Marty