Adverse Drug Reaction - SMZ

[mel_la_fee]

*Note -wasn't sure where to put this so Mods please assign/move it as you see fit.

Hey everyone,

I rarely chime in unless I really need help so, you might not recognize me even though I’ve been around for awhile. I just wanted to talk about a recent issue I had with my little neuro Cleo (2 yrs old), because it might be pertinent to others treating their squirrels with antibiotics. Also this is a loooong post. You have been advised!

Full disclosure, I am not a veterinarian or even a vet tech. I have a license to personally maintain certain Florida wildlife (raccoons and skunks) and have successfully rehabilitated many squirrels (which you do not need a license for in FL), but I am not an expert on medication, dosing, or drug interactions. One of the reasons I love this site is because so many people here have the experience I lack and I can ask questions when I encounter a new problem. So, please, take this with a grain of (anecdotal) salt, but I felt it was worth sharing.

My little Cleo is quite possibly one of the most non-releasable squirrels you will ever see (I've posted about her a couple of times). I have multiple x-rays and will at some point write a full piece about her detailing her issues. For now, just know that she has a persistent sinus infection that must be treated with antibiotics almost continuously. She has weeks where it seems to be gone, but we always end up back at the vet’s eventually. Mind you, this creature has a will to live that is enviable by any standard. She seems to not know at all what she is missing out on, and if she does have any idea, she clearly doesn’t care. It’s quite inspirational.

I know I will have to deal with the loss of her eventually, but last week I had to grapple with the reality of that much sooner than expected. She had been to the vet for new ABs and a teeth trim the weekend before and seemed fine, but started to get lethargic just a few days later. She also did this weird thing where she shivered/trembled almost rhythmically over and over when she curled up to sleep. She was still eating and drinking and going to the bathroom so I presumed her condition was due to her constant infection, and since we had put her on new antibiotics I thought it would get better soon. By Sunday she was even more lethargic and acting disoriented whenever she was awake, but bodily functions were continuing on schedule (well, not a schedule really but you know what I mean) but she was eating less and refusing formula entirely. By Monday afternoon, she didn’t want to be awake for any period of time, ate or drank very little, and could hardly get around. I naturally thought of MBD even though she eats HHBs, gets no nuts or seeds except for the occasional almond to offset seizures (low-phosphorus diet in general), and lives in a room with plenty of sunlight and a UV lamp. Anytime you have an indoor squirrel, MBD should be something you look out for, and right away I put her on a heating pad and started following the calcium protocol just to be on the safe side.
I also bought new liquid calcium, new uv bulbs (what if the old ones weren’t working well anymore?), and scheduled a vet appointment.

We went in first thing Wed morning and did new x-rays, bloodwork, the whole nine, and spent a very pretty penny. On Thurs her bloodwork came back and showed some issues related to her bacterial infection that were expected (high white cell count, etc) but that the antibiotics were working. It also showed she was dehydrated and hypoglycemic, which I related to the fact that she was not eating or drinking very much prior to the visit. The vet tech who called to relay the information said that MBD wasn’t apparent, but as I had already started supplementing, it could not be ruled out and we needed to see what the radiologist said about her x-rays. So I should continue what I was doing.

Friday afternoon she would no longer eat or drink anything. I managed to force some pasty, berry-flavored tums into her (my liquid calcium hadn’t arrived on time- damn you, Amazon) and getting plain, elemental calcium water into her proved next to impossible, as did everything else. Anything I put into her mouth she let dribble down her chin with her mouth just hanging open. She didn’t even try to swallow, despite being very dehydrated. I managed to get water into her by dropping some into her mouth and rubbing her throat, but when I later tried this with vanilla Boost for children (as she had already refused formula multiple times), she slightly aspirated on it before I’d even given her even 1cc. Like, aspirational pneumonia is EXACTLY what I wanted to add to this situation (insert some kind of frustrated weeping emoji)….I cursed myself, but tried to entice her again with all of her favorite foods, even if they weren’t the best things for her. She just shook her head and gazed around glassy-eyed before falling to her side and sleeping/trembling. She no longer even cared to curl up or get in a comfortable position. She slept where you put her or where she dropped, that’s how weak she was. I had to constantly force her to drink and then carry her to her ‘pee-rug’ to go to the bathroom.

It goes without saying I’d been crying almost continuously since Monday. I went over every possible thing I might’ve done wrong or taken for granted. If it was MBD, why, after 5 days had she only continued to decline? The bloodwork showed that calcium levels in her blood were up...no other factors had presented themselves as being very problematic... In fact, the vet tech told me that according to their tests, she should be doing better. I was a mess and scoured this forum relentlessly looking for an answer.

Finally, it occurred to me that the only real change in our routine had been in her antibiotics. We’d moved from using Baytril to SMZ because we were afraid her bacterial infection had grown resistant. My sister used to work in a hospital and did some of her hours in the E.R. so I asked her how long it would typically take to see an adverse drug reaction. I expected her to tell me minutes or hours, but she actually said it could take a few days, though usually less than 2 weeks. That would be in humans, of course, but it sent me on a quest nonetheless. I found that plenty of symptoms Cleo had were noted in dogs or horses or people. I didn’t think that counted as evidence, so I dug a little deeper into google and found a clinical trial for SMZ using rats. It noted anorexia, hypoglycemia, disorientation, lethargy and weakness. Granted, these trials were probably using larger doses than a rat would ordinarily require, for testing purposes. They may have been using the drug more frequently than it would ever be prescribed, just to see what it did. That means the effects of the drug might be exaggerated or the results inconclusive for my purposes. It made me sad for the rats… it also made me stop the SMZ antibiotic I had been giving to Cleo.

I don’t know that it caused her issues or decline for sure. I’m not an expert. What I do know is that several hours after her first skipped dose I was finally able to interest her in a tiny piece of papaya and she willingly drank 7.5cc of hydration solution. That was after a full day of refusing everything I tried, including millennial favs like avocados and almonds, and water when she was observably dehydrated. Here it is, almost a full week after I thought I was going to lose her and she’s back to being my baby. By which I mean, she is awake before I am, wrestling with her blanket, grunting at me to keep my distance while she’s eating her blocks, and behaving like the obstinate jerk I love again.

Now, SMZ is actually considered very safe, and I don’t want anyone thinking I’m advocating we never use it. Sometimes it’s necessary and the side effects I mentioned/found are generally rare. That’s one of the reasons it hadn’t occurred to me as a possible problem in the beginning. By all accounts it should still be in your lexicon of drugs that can be used for squirrels, if that’s what your vet prescribes or what is pertinent to your specific problem, because it has saved lives.
I’m only trying to point out that even ‘safe’ drugs might not work for every animal, just as they might not work for every person. It’s important to observe your furr-kids and monitor them.That tremble/shaking that Cleo had was one of the first signs (it has since completely vanished) but it was a small thing that not everyone would notice right away. It was something you could only feel if you were holding her or supporting her with your hand and paying attention. Unfortunately, I didn’t know what it meant. Sometimes the signs aren’t completely obvious. They become obvious sooner or later, but by then you’re waging a war against time. I feel awful that I didn’t recognize the problem sooner... Right up until Friday evening, the 2 things I was sure she had gotten every day were calcium and her antibiotics.

I’ll also make clear that after stopping her ABs on Friday, I went to the vet again on Sat. because even though I chose to stop the SMZ, that’s still the kind of thing you should bring up with your practitioner. While they couldn’t confirm my report of adverse effects (she was still very lethargic and we’d only skipped 2 doses by then), they also didn’t disbelieve me. My vet put her back on Baytril to deal with her infection. The reversal of symptoms was even more noticeable after a full 24 hrs of stopping the SMZ, and my girl is basically back to normal (well, her normal!).
So, overall, trust your vet, but trust your instincts as well, and be willing to look at every aspect of a situation, even if it doesn’t make sense. Our babies can’t speak for themselves so someone who watches them must always be paying attention.

P.S. Still waiting on x-ray results, but my liquid calcium came in finally so we’re going to continue with mild calcium supplementation until I hear to do otherwise.