Introduction
1 General information and practical advice on CBS
- What is the difference between a syndrome and a symptom?
- What is CBS (calcified bulla syndrome)?
- How can CBS be diagnosed?
- What is causing CBS and how can I minimise the risk?
- Vet care and customer rights with newly bought guinea pigs
- Support and care information resources
- Leaflet with list of CBS symptoms and comparison x-ray pictures
2 Other common neurological problems
- Disconcerting normal behaviours
- Neurological and CBS symptoms with more than one cause
- Seizures - symptoms and causes
- E.cuniculi
- Strokes
3 Home care tips, welfare and end of life considerations
Introduction
CBS is a newly identified complex of mostly neurological but also some physical symptoms that your vet will not be aware of.
This is the reason why we include original the original leaflet and pictures from Saskia Chiesa from Los Angeles Guinea Pig Rescue by her wish and with her express permission in order to give any diagnosing vet of yours the tools to check for it and to be able to identify it.
Please bookmark the link or copy the text when seeing a vet for potential CBS.
The full story of how Saskia Chiesa and her vet, DR Nenn, have discovered CBS syndrome can be read in Guinea Pig Magazine issue 66, January 2022 where it has been first published and where the copyright remains with.
Guinea Pig Magazine website: Home
Symptoms of CBS can overlap or be very similar to other neurological or non-neurological health issues. For this reason, we have in Part 2 of this thread included a discussion of other neurological problems and a list of common CBS symptoms that can have other causes.
Part 1: General information and practical advice on CBS
What is the difference between a syndrome and a symptom?
A syndrome means that it is not a single symptom but a distinct combination of sometimes seemingly disparate symptoms and a distinct progression of the illness that has just one single cause.
Every single symptom on its own can also have other causes; that is why you should be extremely careful when throwing CBS into the round on social media or if you suffer from pet anxiety.
Please also be aware that CBS is NOT good news and is bound to greatly upset the owner, so don’t use your newly gained knowledge to show off of for your own gratification. Be sensitive and kind when introducing it into a discussion where there are at least 2 or more of the characteristic symptoms present. This is not a health issue to play one-upmanship with! An x-ray is very expensive, so make sure that any mention of CBS is justified because many owners will struggle to pay for it.
What is CBS (calcified bulla syndrome)?
CBS is caused by quite a wide range of un- or undertreated bacteria moving eventually into the middle ear capsule, causing chronic middle ear infection and walling it off as the bone becomes affected.
This causes intense vertigo and some pain in the jaw, which is as the bottom of the most commonly seen balance and mobility issues. It can cause repeated or seemingly resistant URI, nasal discharge, increased eye discharge and even blindness, affect the ears and also very often impact on the jaws (making chewing difficult/weaker) and then as a secondary complication can in some cases cause dental overgrowth problems with the need for support feeding and regular dentals with secondary long term digestive issues if the diet is unbalanced as a result of the piggies not eating enough hay/grass fibre in their diet (either directly or as a powdered recovery formula).
CBS can range from only very mild symptoms that require regular vet checks but no special medical treatment to an aggressive sudden onset and progression form that can totally incapacitate a guinea pig in a matter of just a few weeks and require euthanasia. The combination of symptoms can vary but there is a certain characteristic progression especially in the later stages that is distinct from other neurological problems.
The problem is that once the bacteria have walled themselves in, antibiotics struggle to reach them. Treatment and support care has to mainly focus on easing and addressing the symptoms as much as possible to provide quality of life for as long as normal species behaviours and a zest for life are possible and expressed.
How can CBS be diagnosed?
CBS can be easily diagnosed on an x-ray because the middle ear capsules (the two large bullas at the back of the head behind the eye sockets (see reference x-rays attached to the leaflet below) appear as light blobs and not as rings with a dark centre.
CBS is not an instant killer; the slow version can take months or years to progress while the fast onset will still take several weeks with a quite noticeable quick deterioration of balance/neurogical symptoms and increasing mobility issues before it is time to euthanize.
Please make sure that you can afford the vet fees to at least spare your CBS piggies any unnecessary suffering!
What is causing CBS and what can I do to minimise the risk of it developing?
CBS is very much a human generated problem caused by the current commercial mass breeding and sales practices that provide an ideal breeding ground for bacteria in groups of highly stressed young guinea pigs with a not yet fully developed immune system in close proximity where exposure and contagion is great but medical care is not provided.
While other bacteria can cause the syndrome as well (especially various streptococcus or pneumoccus), CBS is currently typically seen in pet store guinea pigs in North America which have been exposed to respiratory bacteria (URI). By far not all of them will ever develop CBS or show the full symptoms of a URI but even a small load of unrecognised and untreated bacteria can eventually get into the bulla and cause CBS.
CBS can also happen in other countries and continents but it is much less common right now.
If you have newly bought guinea pigs with a constant/frequent sniffle/repeatedly wet nose, raspy or crackly breathing, eyes closed with yellowish/greenish mucus etc., then please see a vet promptly for antibiotic treatment. If symptoms have not disappeared by the end of the course, then ask for another one or a different antibiotic. This is important to make sure that there is no bacterial load left.
What are my customer rights in terms of vet care in newly bought guinea pigs?
If you see a vet with guinea pigs with a potential respiratory infection (URI) within 2-3 weeks (UK) / 30 days (North America) of purchase you can reclaim any vet cost/treatment cost by producing your sales receipt together with the vet bill. This is your right because you have in effect been sold faulty ware.
If necessary insist to see the manager and please DO NOT let yourself be fobbed off in selling your guinea pigs back to the shop for the duration of treatment because that will deprive you of your ownership and any legal standing against the shop to get your purchased guinea pig back. Sadly it is a rather common trick especially in the USA and Canada.
More information in this link here:
Where can I get support for the care of guinea pigs with CBS?
The Guinea Pig Forum can help you with the potential identification of CBS and can support you with ongoing practical care tips for your particular symptoms and friendly moral support once it has been diagnosed, but if you want more experienced help, please join Saskia’s USA-based Wheekers! group on Facebook.
Wheekers! Guinea Pig Group Saskia, volunteers and Friends of LAGPR
For practical support care at home and ethical end of life/euthanizing considerations please see the last chapter of this guide.
Leaflet with list of symptoms and comparison x-ray
This leaflet and the reference x-ray pictures are shared with the express permission of Saskia Chiesa.
We have included the text of her own leaflet below as well as reference x-rays courtesy of Los Angeles Guinea Pig Rescue (which is run by Saskia Chiesa) in this guide so that you can show the medical information to your vet since they will most likely not have heard of it.
Calcified Bulla Syndrome (CBS): Medical Information
This is the paper I hand out with Dr Nenn’s blessing as she has read it and has been beside me with every discovery we have made this past year.
Reference x-rays for comparison
The walled-off bullae are very distinctive on an x-ray of the head and can be quite easily (if not cheaply) diagnosed this way. They appear as bright blobs behind the eye sockets instead of as healthy rings. The difference is very striking, even in guinea pigs with only mild symptoms.
Healthy transparent bullae vs. walled-off diseased bullae (middle ear capsules)
Symptoms
Not all these symptoms have to present for the syndrome to be diagnosed.
One or two symptoms are often enough to create a suspicion and a simple head x-ray will confirm the diagnosis. The more symptoms your guinea pigs presents with, the higher the chance the animal will be a special needs patient.
Frequent or chronic Upper Respiratory Infections (seemingly antibiotic resistant)
Pneumonia
Runny Nose - One or both nostrils
Head tilt
Drooping lips on one side
Missing blink reflex
Involuntary twitching of the ear
Extreme sensitivity of the ears
Overactive production of white grooming liquid – usually in one eye
Ulcerated eye
Blindness one or both eyes
Deafness one or both ears (Do the clap test right behind your pig so they can’t see you doing it)
Vertigo
Wobbling
Going in circles
Sneezing
Ear twitches
Weak bite strength (often characterized by the inability to put food in the mouth despite trying)
Leaky eye, one or both sides
Falling over
Molar issues – recurring dental work
Loose stool from recurring antibiotic use, including permanent damage
Causes
The cause appears to come from untreated URI’s or URI’s not treated on time.
A lot of babies for instance purchased from one of the big name pet stores suffer from URI that do not always get immediate treatment or receive treatment when it is too late. Owners may think the URI symptoms are an allergy for instance.
The nose, throat and ears are all connected. In an animal that does not receive timely antibiotic treatment, the bacteria that cause CBS are free to travel and make their way to the middle ear to settle in the bulla. Once there, antibiotics will not be able to reach and the bulla responds to the invaders by creating a wall of calcium that is very easy to spot on an x-ray.
How does this affect the infected guinea pig?
These symptoms happen because the antibiotics are never quite able to kill the bacteria as they hide in the bulla where they multiply and circulate freely through the nose and throat area. I believe that this is why we see an antibiotic work for just a few months at most before a URI returns.
The raging infection will attack the ears mimicking an ear infection - I say mimicking because a key symptom of a “real” ear infection is not present since the smelly pus coming from the ear and often a head tilt is missing. A “regular” ear infection usually will respond to medication and CBS does not.
The calcium build up in the ear can cause a head tilt. Some tilts are more severe than others. These cause vertigo in some cases where the animal loses balance, sways, goes in circles and falls over. They often learn to live with these symptoms so the severity may decrease in time. Sometimes an animal is observed wobbling its head in an up and down manner and or side to side and also holding its head up high. This is caused by blindness and the pig’s attempt to compensate and cope with the disability.
Eating – Teeth
In extremely severe cases, the facial nerve on the side the head is tilting towards becomes affected and this causes dry eye as the blink reflex is no longer there. An inability to eat properly could result if the jaw muscle is also affected. Hay is likely the first thing the pig will stop eating, as the jaw strength needed to grind the rough hay has is absent. The pig will likely gravitate to softer foods and will have a hard time chewing food. Observe your pig eating. Are they just chewing endlessly or swallowing the food and dipping down for the second bite fairly fast?
This is quite a serious affliction that a lot of guinea pigs are suffering from without their owners being aware.
1 General information and practical advice on CBS
- What is the difference between a syndrome and a symptom?
- What is CBS (calcified bulla syndrome)?
- How can CBS be diagnosed?
- What is causing CBS and how can I minimise the risk?
- Vet care and customer rights with newly bought guinea pigs
- Support and care information resources
- Leaflet with list of CBS symptoms and comparison x-ray pictures
2 Other common neurological problems
- Disconcerting normal behaviours
- Neurological and CBS symptoms with more than one cause
- Seizures - symptoms and causes
- E.cuniculi
- Strokes
3 Home care tips, welfare and end of life considerations
Introduction
CBS is a newly identified complex of mostly neurological but also some physical symptoms that your vet will not be aware of.
This is the reason why we include original the original leaflet and pictures from Saskia Chiesa from Los Angeles Guinea Pig Rescue by her wish and with her express permission in order to give any diagnosing vet of yours the tools to check for it and to be able to identify it.
Please bookmark the link or copy the text when seeing a vet for potential CBS.
The full story of how Saskia Chiesa and her vet, DR Nenn, have discovered CBS syndrome can be read in Guinea Pig Magazine issue 66, January 2022 where it has been first published and where the copyright remains with.
Guinea Pig Magazine website: Home
Symptoms of CBS can overlap or be very similar to other neurological or non-neurological health issues. For this reason, we have in Part 2 of this thread included a discussion of other neurological problems and a list of common CBS symptoms that can have other causes.
Part 1: General information and practical advice on CBS
What is the difference between a syndrome and a symptom?
A syndrome means that it is not a single symptom but a distinct combination of sometimes seemingly disparate symptoms and a distinct progression of the illness that has just one single cause.
Every single symptom on its own can also have other causes; that is why you should be extremely careful when throwing CBS into the round on social media or if you suffer from pet anxiety.
Please also be aware that CBS is NOT good news and is bound to greatly upset the owner, so don’t use your newly gained knowledge to show off of for your own gratification. Be sensitive and kind when introducing it into a discussion where there are at least 2 or more of the characteristic symptoms present. This is not a health issue to play one-upmanship with! An x-ray is very expensive, so make sure that any mention of CBS is justified because many owners will struggle to pay for it.
What is CBS (calcified bulla syndrome)?
CBS is caused by quite a wide range of un- or undertreated bacteria moving eventually into the middle ear capsule, causing chronic middle ear infection and walling it off as the bone becomes affected.
This causes intense vertigo and some pain in the jaw, which is as the bottom of the most commonly seen balance and mobility issues. It can cause repeated or seemingly resistant URI, nasal discharge, increased eye discharge and even blindness, affect the ears and also very often impact on the jaws (making chewing difficult/weaker) and then as a secondary complication can in some cases cause dental overgrowth problems with the need for support feeding and regular dentals with secondary long term digestive issues if the diet is unbalanced as a result of the piggies not eating enough hay/grass fibre in their diet (either directly or as a powdered recovery formula).
CBS can range from only very mild symptoms that require regular vet checks but no special medical treatment to an aggressive sudden onset and progression form that can totally incapacitate a guinea pig in a matter of just a few weeks and require euthanasia. The combination of symptoms can vary but there is a certain characteristic progression especially in the later stages that is distinct from other neurological problems.
The problem is that once the bacteria have walled themselves in, antibiotics struggle to reach them. Treatment and support care has to mainly focus on easing and addressing the symptoms as much as possible to provide quality of life for as long as normal species behaviours and a zest for life are possible and expressed.
How can CBS be diagnosed?
CBS can be easily diagnosed on an x-ray because the middle ear capsules (the two large bullas at the back of the head behind the eye sockets (see reference x-rays attached to the leaflet below) appear as light blobs and not as rings with a dark centre.
CBS is not an instant killer; the slow version can take months or years to progress while the fast onset will still take several weeks with a quite noticeable quick deterioration of balance/neurogical symptoms and increasing mobility issues before it is time to euthanize.
Please make sure that you can afford the vet fees to at least spare your CBS piggies any unnecessary suffering!
What is causing CBS and what can I do to minimise the risk of it developing?
CBS is very much a human generated problem caused by the current commercial mass breeding and sales practices that provide an ideal breeding ground for bacteria in groups of highly stressed young guinea pigs with a not yet fully developed immune system in close proximity where exposure and contagion is great but medical care is not provided.
While other bacteria can cause the syndrome as well (especially various streptococcus or pneumoccus), CBS is currently typically seen in pet store guinea pigs in North America which have been exposed to respiratory bacteria (URI). By far not all of them will ever develop CBS or show the full symptoms of a URI but even a small load of unrecognised and untreated bacteria can eventually get into the bulla and cause CBS.
CBS can also happen in other countries and continents but it is much less common right now.
If you have newly bought guinea pigs with a constant/frequent sniffle/repeatedly wet nose, raspy or crackly breathing, eyes closed with yellowish/greenish mucus etc., then please see a vet promptly for antibiotic treatment. If symptoms have not disappeared by the end of the course, then ask for another one or a different antibiotic. This is important to make sure that there is no bacterial load left.
What are my customer rights in terms of vet care in newly bought guinea pigs?
If you see a vet with guinea pigs with a potential respiratory infection (URI) within 2-3 weeks (UK) / 30 days (North America) of purchase you can reclaim any vet cost/treatment cost by producing your sales receipt together with the vet bill. This is your right because you have in effect been sold faulty ware.
If necessary insist to see the manager and please DO NOT let yourself be fobbed off in selling your guinea pigs back to the shop for the duration of treatment because that will deprive you of your ownership and any legal standing against the shop to get your purchased guinea pig back. Sadly it is a rather common trick especially in the USA and Canada.
More information in this link here:
Where can I get support for the care of guinea pigs with CBS?
The Guinea Pig Forum can help you with the potential identification of CBS and can support you with ongoing practical care tips for your particular symptoms and friendly moral support once it has been diagnosed, but if you want more experienced help, please join Saskia’s USA-based Wheekers! group on Facebook.
Wheekers! Guinea Pig Group Saskia, volunteers and Friends of LAGPR
For practical support care at home and ethical end of life/euthanizing considerations please see the last chapter of this guide.
Leaflet with list of symptoms and comparison x-ray
This leaflet and the reference x-ray pictures are shared with the express permission of Saskia Chiesa.
We have included the text of her own leaflet below as well as reference x-rays courtesy of Los Angeles Guinea Pig Rescue (which is run by Saskia Chiesa) in this guide so that you can show the medical information to your vet since they will most likely not have heard of it.
Calcified Bulla Syndrome (CBS): Medical Information
This is the paper I hand out with Dr Nenn’s blessing as she has read it and has been beside me with every discovery we have made this past year.
Reference x-rays for comparison
The walled-off bullae are very distinctive on an x-ray of the head and can be quite easily (if not cheaply) diagnosed this way. They appear as bright blobs behind the eye sockets instead of as healthy rings. The difference is very striking, even in guinea pigs with only mild symptoms.
Healthy transparent bullae vs. walled-off diseased bullae (middle ear capsules)
Symptoms
Not all these symptoms have to present for the syndrome to be diagnosed.
One or two symptoms are often enough to create a suspicion and a simple head x-ray will confirm the diagnosis. The more symptoms your guinea pigs presents with, the higher the chance the animal will be a special needs patient.
Frequent or chronic Upper Respiratory Infections (seemingly antibiotic resistant)
Pneumonia
Runny Nose - One or both nostrils
Head tilt
Drooping lips on one side
Missing blink reflex
Involuntary twitching of the ear
Extreme sensitivity of the ears
Overactive production of white grooming liquid – usually in one eye
Ulcerated eye
Blindness one or both eyes
Deafness one or both ears (Do the clap test right behind your pig so they can’t see you doing it)
Vertigo
Wobbling
Going in circles
Sneezing
Ear twitches
Weak bite strength (often characterized by the inability to put food in the mouth despite trying)
Leaky eye, one or both sides
Falling over
Molar issues – recurring dental work
Loose stool from recurring antibiotic use, including permanent damage
Causes
The cause appears to come from untreated URI’s or URI’s not treated on time.
A lot of babies for instance purchased from one of the big name pet stores suffer from URI that do not always get immediate treatment or receive treatment when it is too late. Owners may think the URI symptoms are an allergy for instance.
The nose, throat and ears are all connected. In an animal that does not receive timely antibiotic treatment, the bacteria that cause CBS are free to travel and make their way to the middle ear to settle in the bulla. Once there, antibiotics will not be able to reach and the bulla responds to the invaders by creating a wall of calcium that is very easy to spot on an x-ray.
How does this affect the infected guinea pig?
These symptoms happen because the antibiotics are never quite able to kill the bacteria as they hide in the bulla where they multiply and circulate freely through the nose and throat area. I believe that this is why we see an antibiotic work for just a few months at most before a URI returns.
The raging infection will attack the ears mimicking an ear infection - I say mimicking because a key symptom of a “real” ear infection is not present since the smelly pus coming from the ear and often a head tilt is missing. A “regular” ear infection usually will respond to medication and CBS does not.
The calcium build up in the ear can cause a head tilt. Some tilts are more severe than others. These cause vertigo in some cases where the animal loses balance, sways, goes in circles and falls over. They often learn to live with these symptoms so the severity may decrease in time. Sometimes an animal is observed wobbling its head in an up and down manner and or side to side and also holding its head up high. This is caused by blindness and the pig’s attempt to compensate and cope with the disability.
Eating – Teeth
In extremely severe cases, the facial nerve on the side the head is tilting towards becomes affected and this causes dry eye as the blink reflex is no longer there. An inability to eat properly could result if the jaw muscle is also affected. Hay is likely the first thing the pig will stop eating, as the jaw strength needed to grind the rough hay has is absent. The pig will likely gravitate to softer foods and will have a hard time chewing food. Observe your pig eating. Are they just chewing endlessly or swallowing the food and dipping down for the second bite fairly fast?
This is quite a serious affliction that a lot of guinea pigs are suffering from without their owners being aware.
