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| Sasha's Miracle and More (follow-ups: september 2005, july 2007, september 2007, november 2007, february 2008, march 2008, april 2008, may 2008, august 2008, conclusion- december 2008) Please read this article in its entirety if at all, because it includes our mistakes and lessons learned! We, the ChinCare webmasters, knew that Sasha might not live into old age after viewing the head x-rays we had taken of her some months after we took her home from a pet store (x-ray photos, from 2001 on left to 2003 on right). Our first sign that something wasn't right was when we observed her whitish tooth enamel, indicating a serious calcium deficiency. Her incisors tended to overgrow, resulting in trips to our exotics specialist vet to get her teeth trimmed. The photo in the left x-ray shows the advancing malocclusion: misaligned roots overgrown and extending towards the sinus and ocular cavities. The root overgrowth in that photo is illustrative of mid (almost advanced) stage malocclusion. 
Two years later, in 2003, after having access to a variety of
chew
toys and a good diet that included several high quality hays
and pellets dusted
with supplementary powdered vitamin
C and calcium,
not to mention prayers for our darling girl, we saw a miracle! See
right
x-ray. Not only had Sasha's roots RECEDED from their growth toward
the sinus and ocular cavities, but they had even STRAIGHTENED out
as well! Our vet even measured the difference on the head x-rays for
herself, we were both astounded at this malocclusion reversal. On
that visit Sasha had a couple molar spurs clipped to make it easier
for her to consume more hay, which will keep her molars filed
down. This was the first time we realized the connection
between vitamin
C and calcium
supplementing and how they can positively affect malocclusion.
FOLLOW-UP, SEPTEMBER, 2005: We're happy to report that Sasha's condition has continued to improve, in fact, we haven't had to trim her incisors AT ALL for several months now. Her teeth have gained some dark yellow enamel, which indicates that her calcium levels are improving, progressing in the right direction, toward dark orange. Sasha's lingering calcium deficiency is clearly the result of an inherited calcium deficiency, as evidenced by the fact that her teeth hadn't darkened during or even well after the weaning period. When a mother chinchilla has low calcium levels, the offspring are consequently short of calcium from the start, and both mother and kits become at risk for calcium deficiency and malocclusion in the future. This is why we advise both vitamin C and calcium supplementing for pregnant/ nursing chins, their bodies are being depleted by the process of creating and nourishing new life. JULY, 2007: For about five months between late 2005 and early 2006 we switched from supplementing the Ca:no P (calcium: no phosphorus) that we'd used since 2001 to a powder (T-Rex 2:1) containing 2 parts calcium to 1 part phosphorus. The problem with this, which involves how excess phosphorus causes calcium deficiency, is discussed in Calcium Metabolism; its tragic impact on our chins, especially our resident maloccluders, is elaborated on in Moderate Ca:no P Calcium Supplementing and the March, 2008 entry of this section. Sasha is one of the maloccluders who suffered greatly from calcium loss at this time. In July of 2007, Sasha's tooth enamel was finally becoming dark orange when she experienced some weight loss, had dampness around the chin and was pawing at her mouth, so we made a vet appointment for July 31 to get a head x-ray. The x-ray revealed a case of Osteomyelitis, a bone infection caused by significant molar root elongation going right through the lower jaw. The infection, located on the left side of her jaw, is making it very painful for her to eat. The roots in her upper jaw have also begun to grow crooked and advance again toward the sinus and ocular cavities. At this appointment we also had head x-rays taken of two of our other maloccluders who had, like Sasha, been in remission prior to using T-Rex 2:1. Altogether these three x-rays demonstrate the awful consequences incurred by our maloccluders (other maloccluders that went through the T-Rex 2:1 tragedy had to be euthanized or died of natural causes, the three still struggling as of this July appointment are discussed in the March, 2008 entry) as a result of using T-Rex 2:1 and the subsequent slow recovery period; their malocclusion is back, they have regressed. As a result of the July 31 appointment, our vet has prescribed Septra (medication) and Novadent (mouth wash) to treat the Osteomyelitis, and we have begun intensive calcium supplementing, which we define as supplementing from more than one source or greater quantities from a single source. For Sasha, that will mean administering calcium from these two sources: Coral Calcium Complex Liquid plus her usual pellets dusted with Ca:no P in the form of Fluker's Repta-Calcium (with vitamin D (.doc) to aid calcium absorption). We also continue to dust our pellets with vitamin C, currently in the form of rose hips powder, because vitamin C has dental benefits for chins in any condition. We're hoping that intensive calcium supplementing will bring about another malocclusion reversal such as she experienced before. Sasha's intake of herb and grains mix and unsweetened Wheat 'N Bran mini Shredded Wheat biscuits has been increased somewhat because she sometimes finds it difficult to chew her pellets, and the herb and grains mix is stirred into her bowl of pellets (which she shares with her neutered mate, mentioned in the March, 2008 entry), coating it with Ca:no P. The additional grains will increase her phosphorus levels some, but not much because she's no longer able to eat hay to acquire phosphorus from that, and anyway, with intensive calcium supplementing a small increase in phosphorus should be just fine. SEPTEMBER, 2007: The head x-rays from the September 25 follow-up appointment show little improvement with the Osteomyelitis condition, and even though her teeth have become much thicker and stronger with the intensive calcium supplementing (twice as thick as before, actually), there has been no change in the root overgrowth. The vet and I did consider euthanasia at this point, but at my husband's prompting, our vet prescribed a stronger medication, Vibramycin, to fight the Osteomyelitis. We also switched from the previous liquid calcium to vet-prescribed liquid calcium gluconate (one full syringe of this liquid calcium, Ca:no P, twice daily while continuing with the pellets and herb/ grains dusted with Fluker's calcium and rose hips powder for vitamin C) and we've begun administering the painkiller Metacam. NOVEMBER, 2007: There was a period of about ten days at the beginning of November when Sasha was no longer able to eat on her own and she required daily handfeeding to keep her weight and strength up. Often she'd let us know that she wanted to be fed, her appetite was very good and she'd eat all she wanted about three times a day on average. Then one day she suddenly refused the handfeeding formula and was seen eating her pellets again! What a trooper! The head x-rays for her November 30 vet appointment show that the Osteomyelitis has entirely cleared up, but root overgrowth is pretty much the same. We believe that the painkiller had a major impact on Sasha's ability to eat and recover enough strength to overcome the Osteomyelitis. Now that the Osteomyelitis is gone and the painkiller is allowing her to eat pain-free, the fur is growing back over her paws because she's no longer drooling and wiping her mouth. While she was, though, we kept her wiped with a warm, damp cloth and then dried well with a towel or blow drier; it's VERY important to keep maloccluders clean, it keeps their spirits up, and Sasha's stayed happy and active despite her troubles. Also, because Sasha's experienced significant weight loss and it's the cold weather season where we live, we've been keeping a small heater near her cage. These things (keeping maloccluders clean and warm) are stressed on Implementing Changes. We're continuing with the September 25 regimen, but we've halved the dosage of Vibramycin and liquid calcium gluconate. The Metacam dosage, a very tiny drop twice daily, has had to remain the same because otherwise she experiences too much pain from the molar root elongation in her lower jaw to make normal eating possible. Our continued hope is that by persisting with the intensive calcium supplementing (one full syringe of liquid calcium gluconate once daily while continuing with the pellets and herb/ grains, which now also includes some Kashi 7 Whole Grain Puffs, all dusted with Fluker's calcium and rose hips powder for vitamin C), that Sasha's roots will eventually recede so that she can live a normal life again, without medication and painkillers. FEBRUARY, 2008: By mid-December we had to put Sasha back on her full dosage of Vibramycin, but in January she was seen eating hay and on January 29 she unlocked her cage with her teeth (like this photo) TWICE in one night, hurray! She was able to go off the Vibramycin after the first week of February and on her February 16 vet appointment, we witnessed yet another miracle! Sasha's head x-rays this time show that her roots are receding and straightening, not nearly as dramatically this time as with the first miracle that occurred over the course of two years, but she's nonetheless making some progress, our vet was as happy and amazed as we were, this is her second malocclusion reversal now. She still has a ways to go, especially with the molar root elongation in the lower jaw, but she's moving in the right direction and has continued eating her hay. We're continuing with the Metacam twice daily and the intensive calcium supplementing as described in the previous entry. The head x-rays showing Sasha's progress cracked later on, after they dried, and it affected the picture so we'll have to get another head x-ray at a future date to show this second malocclusion reversal. (update: see December, 2008 entry) MARCH 2008, A synopsis of the others receiving intensive calcium supplementing: Sasha is one chin in a total of three groups of two (6 chins altogether) that have received intensive calcium supplementing since the July 31, 2007 vet appointment; the others have received the same type and dose of calcium that she has as described in the previous entries. As the July, 2007 follow-up and the Moderate Ca:no P Calcium Supplementing article explain, we arrived at the conviction that intensive calcium supplementing was needed to address the lingering calcium deficiency experienced by our maloccluders as a result of the time we used T-Rex 2:1. Sasha's (neutered) mate Guinness had a lingering calcium deficiency that has been corrected by the intensive Ca:no P supplementing, his tooth enamel is now dark orange. A pair of boys, Calvin and Hobbes, arrived at our rescue in spring of 2007 and they were suffering from low bone density caused by calcium deficiency and malnutrition. They had a strange, unhealthy smell about them, were critically underweight, had a constant feeble head nod, became exhausted with very little exertion, their teeth were clear/ white and handling them presented difficulties because their bones were rubbery and insubstantial. They have made major headway since last July as a result of the intensive calcium supplementing: the queer smell is gone, their weight is now in the normal range, their heads don't nod much at all, they keep active for their entire out-of-cage exercise time (often for hours), their teeth have gained some light yellow enamel and their bodies are much more solid and easy to hold because their bones are stronger. Unlike the other two groups with malocclusion and hence chewing issues, these boys are able to eat their pellets and hay and since this fulfills their phosphorus requirement (ref), they have not received additional grains in their diet.
In the third group, Tamba, a neutered male, had a calcium deficiency when we adopted him as a kit from a pet store in 2000; his was an inherited calcium deficiency, same as Sasha. Tamba was beginning to show some real improvement, had finally gained yellow tooth enamel, as a result of the years (since 2001) that we conducted vitamin C and moderate Ca:no P supplementing. After our experience with T-Rex 2:1, Tamba's teeth became white and brittle-looking, although at no time has he yet manifested any malocclusion symptoms, no incisor or molar crown overgrowth, and he's always gnawed his chew toys and consumed hay. His head x-rays from July 31, however, showed molar root elongation in the lower jaw, not as severe as Sasha's condition that was assessed on the same day, but it was clear that he too should receive intensive calcium supplementing. Since the July appointment, the intensive calcium supplementing has made a HUGE difference in Tamba's tooth condition, the white, brittle teeth are now thick, strong and have light yellow enamel. His February 16, 2008 follow-up x-rays show the condition in the lower jaw has remained the same while one tooth root in a back molar of the upper jaw has begun to misalign, to malocclude. We'll continue with the intensive calcium supplementing, as with Sasha our focus with Tamba is to hopefully see a malocclusion reversal. Tamba's mate, Polgara, came to us at age seven in 2001 with one of her lower incisors a bit twisted. Not misaligned, just twisting in place from the root. The tooth continued to twist very slowly over the years, but there were no other problems at all while she was on the moderate Ca:no P supplementing; she gnawed her chew toys, ate hay and her teeth remained a good color, not even getting much lighter during the time we used T-Rex 2:1. After T-Rex 2:1 though, her incisors began overgrowing in response to the calcium deficiency, and her upper incisors began hooking sharply back. The hooking may be attributable to genetic malocclusion, we believe that when teeth twist or hook that this may indicate a genetic propensity rather than an environmental shortcoming (calcium deficiency). In any case, if Polgara's malocclusion is primarily genetic, the calcium deficiency caused by T-Rex-2:1 definitely made things worse. The intensive calcium supplementing has darkened Polgara's teeth to a nice dark orange and the upper incisors aren't hooking back nearly as much as before, but we still do some incisor trimming occasionally to keep overgrowth in check because she's not gnawing. At 14 years old we're guarded about her prognosis because her overall condition has declined (weight loss, some drooling on and off, not as willing to try eating pellets and hay again) despite getting the same medication and painkiller as Sasha. Her head x-rays from July 31 show significant root overgrowth in both the upper and lower jaw which has stayed the same as of the February 16 x-rays.
APRIL, 2008: A couple weeks after the February 16 appointment we had to put Sasha back on the Vibramycin, first at a reduced dosage, then back to full dosage, where she's at now, and she's still receiving Metacam twice daily. Sasha has been able to eat some pellets and hay, but not so with Polgara and for awhile, since both wanted to feed themselves and wouldn't comply with handfeeding, in order to give them something softer that they could eat on their own, we offered some grains cereal in addition to their herb and grains mix. This turned out to be a VERY bad idea, even though the grains cereal was porous and it got coated in the way we only dust their herb and grains mix, with rose hips powder for vitamin C and Ca:no P in the form of Fluker's Repta-Calcium (with vitamin D (.doc) to aid calcium absorption). Sasha, Polgara and their mates were also still getting a full syringe of liquid calcium gluconate once daily, but nonetheless, their mate's teeth began to lighten, revealing calcium deficiency because the supplemented calcium wasn't sufficient to compensate for the excess phosphorus in the additional grains. This has proven to us, again, how very sensitive chins are to raised phosphorus levels, and it emphasizes how grains (high in phosphorus, .doc) or additional phosphorus should never accompany calcium supplementing because it will cancel the benefits of calcium supplementing. (ref) So, in the first week of April we discontinued the grains cereal and increased calcium back to a full syringe of liquid calcium gluconate twice daily. This balancing act that we've been juggling to try and get our maloccluder's situation under control and headed solidly in the right direction underscores the importance of giving chins a simple diet, without a lot of dietary extras, so that deficiencies and malocclusion might be avoided in the first place. On the 16th and 18th, thanks to the gracious kindness of a wonderful friend in England, we received some packages containing Nutrobal and Science Selective Chinchilla, products only available in the UK. Science Selective is a chinchilla feed that's of a different size, shape and consistency than regular pellets, it will be a bit easier for our maloccluders to chew and it's also very porous and easy to coat well with Fluker's calcium and rose hips powder. Nutrobal, a calcium powder and multivitamin/mineral supplement, which isn't for dusting, will be added to the pellets in smaller amounts. We plan to serve these coated pellets to the three groups that have been getting intensive calcium supplementing and we'll see how well they do on that, it'll be the only calcium supplementing they get, which is a bit more than moderate supplementing, since Science Selective is quite porous. It was a beautiful spring day, April 18, when our dear Polgara was euthanized. She would have been 15 years old in August. Her condition had begun to deteriorate in spite of the medication and painkiller, so we made the sad decision to put her to sleep, with our vet's concurrence. Perhaps it was too much to hope for a miracle at her advanced age, even with intensive calcium supplementing, but there is also the very real consideration that her malocclusion was primarily genetic (see March, 2008 entry) and therefore not as responsive to the supplementing as it would have been if she was suffering primarily from malocclusion caused by calcium deficiency. Polgara was a wonderful gal, she will be very deeply missed.
MAY, 2008: I, the webmistress, could not believe my eyes today when, just after midnight on May 18, I heard, then watched Sasha GNAW WOOD!! This in spite of the molar root elongation in her lower jaw which was still considerable from her last head x-ray in February. She's still on Vibramycin and Metacam and the diet as discussed in the previous entry, but because she remains underweight (of course, she's always been a small lanigera type) we've also been offering some Calf Manna vitamin and mineral pellets and Nutri-Cal, a high calorie dietary supplement, both given in moderation of course. 
But this is just incredible, that she is now showing interest in gnawing
for the first time in about a year. Our hopes all along have been
that she'd experience another complete malocclusion reversal that
would make medication and painkillers totally unnecessary, so that
she could again lead a normal life. From that smile on her face in
the picture, one wonders how long she's been gnawing on the sly...
Gnawing puts a good deal of pressure on both the jaw and tooth roots, so this should signify that she's still improving, and indeed her teeth have been gaining darker enamel, as has her mate's and Tamba's. Calvin and Hobbes' tooth enamel is now turning dark orange, so we'll be putting them back on our regular pellets and moderate calcium supplementing regimen. Our primary concern with Sasha has been her lack of weight gain, but maybe we're expecting too much too soon, in any case we're remaining a bit reserved and will save the real rejoicing if we get positive results from her next vet appointment and head x-ray. AUGUST, 2008: The intensive calcium supplementing has ultimately proven to be a great success, a life saver for the three groups (six chins) we used it on, of course with the exception of Polgara (see April, 2008 entry) whose malocclusion was probably more genetic (her teeth were hooking and twisting, not just overgrowing) than calcium deficiency related. Everyone's condition is now well under control, very manageable and steadily improving: Calvin and Hobbes went off treatment in May, Guinness' teeth have darkened as anticipated so he's in the clear, and Tamba and Sasha, the last of the calcium deficiency maloccluders to be recovering from the time we used T-Rex-2:1, are FINALLY in remission! NOTE: The herb and grains mix mentioned in the previous entries, over the course of the year that Sasha battled her second bout of malocclusion, is a recipe that we were working on to improve the condition of some of the ailing chins at our rescue. The final version of the recipe contains NO grains. We are now convinced that chins are better off without high-phosphorus treats, they simply jeopardize calcium levels and ultimately put the chin on the fast track to malocclusion. At the beginning of July, because Tamba and Sasha were improving nicely on the Science Selective diet as described in the April, 2008 entry, we put them back on our regular pellets and moderate calcium supplementing regimen but reintroduced liquid calcium gluconate, ½ syringe once daily, to help expedite their recovery from calcium deficiency. Tamba seems to have a slow calcium absorption rate, always has, so we're going to keep him on the liquid calcium for a while to come to see how that helps. In the meantime, Tamba still gnaws wood and eats hay like a maniac, with that insatiable lust for life that simply epitomizes him, so we have no real worries for him anymore because his malocclusion is a mild case that's being resolved as his calcium deficiency is corrected. As indicated in the previous entry, we had been offering Sasha some Calf Manna vitamin and mineral pellets and Nutri-Cal in moderation to help boost her weight, but we've been able to cut back on that because her weight has dramatically improved, she's now back to her average weight, where she was a year ago when we first detected the recurrence of her malocclusion in July, 2007. It's wonderful to see her in recovery from malocclusion, again. She's got her weight back, continues to gnaw chew toys and as depicted in the August 2 photo below, she chows down on her hay all the time now... she's got her life back! Here are some "then and now" pictures of Sasha: At her low point on November 26, 2007, (read November entry) and now, August 2, 2008 Sasha still gets a tiny drop of Metacam twice a day but as of mid August she no longer needs any additional calcium supplementing (aside from what she'll get through our usual moderate calcium supplementing) and we've been slowly weaning her off the Vibramycin. Due to our hectic personal and chinchilla rescue schedule (including the 2008 Pet Homes For Ranchies Project), we'll be taking Sasha in later this fall for check-up x-rays and we'll conclude this section then. CONCLUSION- DECEMBER, 2008: Sadly, Sasha was still in the process of recovering from her second battle with malocclusion when she died of Osteomyelitis (bone infection) in the early morning hours of Sunday, December 14. On November 14 we had taken her in to our exotics specialist vet for head x-rays, because she had stopped gnawing chew toys and eating hay and there was the faint, rotten smell of infection coming from her mouth. The x-rays confirmed the presence of Osteomyelitis but showed her malocclusion still making progress, tooth roots continuing to straighten and recede, slower than her first reversal but getting there, pretty good for a chin past her prime. X-ray photos showing the progress made during Sasha's second malocclusion reversal (July 2007 on left and December, 2008 on right), which was still underway when she passed from Osteomyelitis. 
At first we thought that the recurrence
of Osteomyelitis, which affected both sides of her lower jaw this
time, may have been the result of weaning her off the Vibramycin (which
treats infection) too soon, even though we had kept her on it
preventatively for nine months following her recovery (see July,
2007 and
November, 2007 entries). As of November, 2008 her lower jaw
tooth roots were still significantly extended through her jawbone
and we thought this may have made her more vulnerable to a recurrence
of Osteomyelitis in the absence of Vibramycin. However, our vet later
clarified for us that Osteomyelitis is more than just an infection,
it's like bone cancer and destroys the architecture of the bone, making
it very difficult to treat and permanently eliminate.Sasha continued to get Metacam after the previous entry, reduced to one tiny drop daily. We anticipated that she would keep taking Metacam until her tooth roots finished receding, but after the November 14 appointment she went back up to a tiny drop of that twice daily, then Vibramycin twice daily and a ¼ syringe of liquid calcium gluconate once daily. By December 3 things were really looking up, Sasha was even back to eating hay regularly. Then, a week later she began to drool and when she opened her mouth the stench of the Osteomyelitis infection could be smelled a couple feet away, indicating advanced toxicity. Our vet prescribed a new antibiotic (Chloramphenicol, a stronger medicine that, like Vibramycin, is able to penetrate bone) in response to this turn for the worst, but Sasha took that for only a couple days before she finally succumbed. Amazingly, she was eating pellets and hay right up until those last few days, when the Osteomyelitis made her jaw too painful to use. On the evening before her death, we held her wrapped in blankets while her mate Guinness ran around in the playroom. They had always been very close, and over the year that Sasha was fighting off malocclusion for a second time Guinness stayed right by her side, providing a strong, cheerful, loving presence. Being a very sensitive chin, we know that he was under a great deal of stress in reaction to her condition in those last days, and just hours before she died he developed a bad case of stress-induced bloat. We put them together, nestled in the blankets, and Sasha passed away at Guinness' side. Just two days later at approximately the same time as her death, despite a vet visit and treatment underway, Guinness joined Sasha in Heaven. Although we feel utterly gutted with grief, we are glad that they never had to live apart, and that they're together now. 
Sasha was such an inspiring, courageous spirit. She battled malocclusion
for almost half of the seven and a half years that she lived, a long
life that would NOT have been possible AT ALL if she hadn't received
vitamin
C and moderate Ca:no P supplementing
early on to correct her calcium deficiency
and reverse her malocclusion. We had people tell us in the beginning
that she should be euthanized because her malocclusion was almost
fatally
advanced, but the supplementing put her malocclusion in remission
after 2003 and she was able to enjoy a happy, carefree life that was
only cut short after we tried
T-Rex 2:1.In honor of Sasha's memory we promise to do all we can to educate others about the prevention and treatment of environmental malocclusion. Rest in peace, our darling angels! |
