Early one Friday night this fall, my male glider Petey made a really unusual sound - it was a lot like a fighting or mating squabble sound, but it had what I can only describe as a "pained quality".  I knew something was wrong, and ran in to see what was up.  I found Petey curled up into a ball
with his mouth near the base of his tail, rolling around on one of his cage shelves.  As I rushed to open the cage, he actually rolled himself right off the shelf, yet kept up the rolling and the sound.  When I reached in and grabbed him, he gave me a hard bite - something he had never done before.  I looked him over, and his anus appeared red and slightly swollen.  I stayed up with him, and he had several other such "attacks".  In between, he acted completely normal, which was really baffling at first.  It became apparent that he was biting at his anus whenever he urinated or defecated - it was causing him pain.  To his credit, it seemed like he was trying to hold himself back from actually biting himself much of the time - as though he knew that would only make it worse - but he still nailed himself good a couple of times, drawing a tiny bit of blood and making a visible flap of loose skin.  Luckily, it wasn't serious damage, but it was scary nonetheless.

     We had read a lot about self mutilation, as well as hearing about the un-named and incurable nematode that could be responsible, and we were terrified.  We stayed up with him all night, holding him in a cloth to keep him from biting himself (getting bit ourselves several times in the process), and got him in to the vet the next morning.  She did a fecal, a general exam, and put him on Panacur (a general wormer) and Pediapred (an anti-inflammatory) for the holiday weekend (three days worth).  She advised us that she had seen many cases of self mutilation in the past, which were caused by an unnamed nematode discovered by her and two vets from California.  She started to prepare us for the worst, telling us that if this was caused by the nematode, there was no cure.

     We were emotional wrecks - we simply adored this little guy.  My husband (Charlie) and I were sleeping in shifts so that we were awake with Petey 24/7.  Even when it was Charlie's shift, the sound of Petey having an attack instantly woke me - many times I was halfway down the hall before I was even fully awake.  His cage-mate, Weezer, seemed to be worried and afraid too. Our vet called us periodically to see how he was doing over the holiday weekend.  He seemed to be getting weaker, and spent much of his time sleeping when he wasn't having an attack.  I cried all weekend, holding my little guy and praying for a miracle.  Such a sweet, special little guy shouldn't have to go through such a horrible problem.  He seemed to be slipping away from us.

     Over the weekend, I had contacted Bourbon to see if she had any information to help.  Bourbon told me that if we could stop the chewing, we were doing well, but she also mentioned that no one had been able to do that. She told us to have a urinalysis done to check for a yeast infection or bladder/kidney
infection, a fecal test done to rule out parasites, and also a bacteria culture.  She gave us some factors that could be contributing causes, including galvanized wire in the cage, or a nest box or other item
in the cage with rough edges that could have caused a scrape.  She also asked us to give her some details of his environment, diet, age, etc. to help the research efforts.

     After the weekend with no change for the better, we took Petey back to the vet early Tuesday morning.  The vet was going to have to put him under to draw some blood and do a thorough exam and x-ray.  She made it painfully clear that anesthesia is very risky and he may not make it through
the procedure.  It took everything I had to leave him there - I sat in the parking lot and cried my heart out, afraid that the next time I saw the little guy, he would be gone.

     The vet did a urinalysis, another fecal, bacteria culture, drew blood for testing, and did an x-ray.  While he was under anesthesia, she extracted his penis and looked it over to make sure there weren't any cuts or scrapes on it.  She checked his skin to make sure there were no mites or other signs of  external parasites or injuries.  She thought it could be bladder stones being passed, which would not only be painful, but could also leave scratches that would be irritated by urine.  When I went to pick him up, the vet told me that Petey had a really hard time coming out of the anesthesia -she hadn't been sure if he was going to come to for a while there.  Again, she seemed to be preparing us for the worst.  When we asked about an e-collar for him, her assistant looked at us sadly and said "it's really not going to
help him".  The vet also started preparing us to consider a necropsy, telling us "if he doesn't make it, put him in a ziploc bag in the refrigerator and call me immediately".  While I understood the benefits to science and to other gliders, this seemed to be heartless and negative.  She told us not to bother
staying up with him, and not to try to keep him from biting himself - that if it was self-mutilation, there was no way to keep it from happening.She seemed to be sure he wasn't going to make it.  I wasn't ready to give up hope.

     The urinalysis was negative for infection, the fecal and skin test didn't show any parasites or mites, and the x-ray showed that his kidneys and liver were normal size and looked fine.  I also asked how his bone density looked, and it was fine.
 
     I told Bourbon that night that I was really hoping they would have come back with something conclusive, so we at least knew what we were dealing with and what to do.  Having the vet and the assistant be so negative about his prognosis was painful and disheartening.  Thank God for Bourbon's support - having someone give me things to consider, some questions to answer, and being supportive and hopeful was exactly what I needed.

Lanacane had been suggested to us,  but the vet said that if it came to that, it was better to get straight lidocaine from the vet, as the other ingredients in Lanacane could be harmful to gliders.  It was also important to only use that in extreme circumstances, because they tend to lick whatever you put on them, and lidocaine numbing of the tongue would keep them from eating/drinking, and could also cause a nasty tongue bite.  She also told us not to use vitamin E oil, unless it was seriously diluted with baby oil (1 drop to 10 ratio), as vitamin E is toxic to pets.  No yeast infection was found.  She also mentioned that if it was an allergy or reaction to the copper, the Pediapred he had been on would have been dealing with that.  We were "on hold" for 24-48 hours to find out the lab results.  In the meantime, Petey was still going at himself, and we were still physically preventing it - Charlie and I both bore the bites to show for it.  The vet had given us Baytril (an antibiotic) and Pediapred (1cc of the combination twice a day for five days).  He was sleeping more and more.  It was very difficult to give him his medication, but we had worked out a two person method - one of us would hold him entirely wrapped in a cloth, with a thumb gently tipping his head back (which opened his lips a little), while the other would gently work the dropper against his side/back teeth until he opened his mouth.  We learned to squirt in a little at a time, as a big mouthful was easy for him to spit out.  He was still eating really well, despite his general lethargy.  When I had mentioned this to the vet, she told us that the wormer he had been on often caused animals to be very sleepy and lethargic (would have been nice to know that up front!).
He was still having frequent attacks - about every 20 minutes (whenever he urinated or defecated) - and things didn't look good.  We were hoping the antibiotic would do the trick.

     After talking to Bourbon about his diet, cage, etc., we made some changes.  I changed his water to bottled water, with a small amount of Pedialyte mixed in.  If you ever need to use this, I recommend getting the Pedialyte popsicles instead of a bottle of it - you use so little at a time, and a full bottle is only good for a short time.  The popsicles can be kept much longer.  I also adjusted his diet somewhat to make it less acidic (he had been eating raspberries every night).  The cage had come with a gorgeous copper roof and nest box - we were afraid that the metal may have caused a chemical reaction
when urinated on, so we promptly removed them.  Upon doing a "cotton ball test" (running a cotton ball over all the surfaces in the cage), we saw that there were some edges in the cage that we hadn't realized were rough - this led to the removal of two shelves, a rough rope, and a chunk of cholla wood.

     While Petey was ill, we had been keeping him in the travel cage while our female stayed in the main cage.  We did this both to make it easier to get him when he had an attack, and also in case the problem was caused by an illness or parasite she could catch.  Bourbon pointed out that the separation could be causing more anxiety than good, and we put them back together (they loved on each other and chattered happily when reunited).  I also took this opportunity to do an extremely thorough cleaning of the cage, with antibacterial dish soap and vinegar, rinsing several times.  I also replaced the shelves with branches cable-tied in (these were a big hit!).

     Charlie got some moleskin and a clear plastic report cover from the drug store, and set about trying to make an e-collar.  He went through a dozen versions before coming up with a small version that was lighter weight and allowed Petey to drink, but not bite himself.  The poor little guy looked like he had a shot glass stuck on his neck!  He had a hard time keeping it lifted, and it would catch on everything, but the little trooper still was playful.  As the wormer medication worked through his system, he started
getting more alert.  Weezer, our female, kept trying to help him take the collar off - even to the point of putting her little foot on his head and pulling at it with both hands.  He stood there patiently the whole
time.  When we told the vet on one of her check-in phone calls that we had made a  collar, she advised us to leave the e-collar on for three or four days, until he was no longer hissing when he urinates/defecates (implying any irritation is healed up), then remove it and see what happens.  She also
mentioned we could remove it for him to eat (he was really having a hard time with that).  Her main caution with e-collars on sugar gliders is to watch carefully to make sure they aren't becoming depressed.  Depression could lead to a swift decline.

     She also mentioned that it's possible his biting was a behavioral problem (but I didn't think so because it had a cause - when he peed/pooped).  If that's it, though, she said it can be treated with Amitriptyline, which is an anti-anxiety/anti-depressant medication used effectively in humans and dogs.

     We removed Petey's collar for a while each night so he could eat. Charlie would rub his little neck and apologize for making it hurt, which Petey just ate up.  The collar was working - which meant we could get a little sleep for the first time in almost a week.  We kept Petey in the travel cage on the bedside table right next to my head at night, and the sound of him playing and clunking the e-collar around was music to my ears!  We couldn't leave Weezer in with him at night, because the smart little girl had learned how to peel off the moleskin.  The collar demanded so much of Petey's attention that he didn't even cry when he had two bowel movements - a success!

     The blood results finally came in, and indicated that his red blood cell count was normal, but that his lymphocytes were more than double what they should be (should be less than 40% of blood volume, his were at 88%).  This could mean a tumor (lymphoma), though it would take further testing later to
determine if that was the problem, or if the lymphocyte count was inflated because of the medication he had been on.  Everything else in the blood was listed as "relatively normal", and she saw nothing else that caused any concern.  If it was lymphoma, the Pediapred he was already on is one of the common treatments.  However, that's not curable, though it is one of the most treatable forms of cancer.  It can be pushed into remission using cortizone, but that would likely only buy him a few weeks to months or so at most.

     The vet also talked with us more about the un-named nematode.  She told us that at this point there is no other way to diagnose it than post-mortem, or if you're lucky enough to get one egg in the fecal test.  She said in the cases they found, there were very few eggs (about 6) in the entire digestive tract.  It's not really an irritation causing the biting, but the migration of an egg through the blood stream to the brain, where it hatches, and then lays more eggs in the brain.  These hatch, which cause neurological
problems, which leads to the self mutilation.  Once the neuro signs are there, it's too late to do anything - there is no cure.  The vet told us that they believe the nematode originally came from wild-caught gliders imported from New Guinea, and that they think it's transferred from mother to child. This made me wonder why gliders aren't wormed by the vet when they are young, like puppies and kittens are.  The vet also mentioned that it's hard to even see patterns of where this is occurring in the US because many owners don't make it to the vet in time or tell the vet when one has died, much less have a
necropsy done so they can document the case.

     We went into a pattern of leaving the collar off during the day while he slept if one of us could work from home that day, then putting it back on for the night after he'd eaten.  He seemed to be getting better, and the attacks were fewer and farther between.  We let him spend one full night with the
collar off, and did not have a single attack.  Charlie thought this was a little anniversary gift from Petey to us, as that day was the 10-year anniversary of the day Charlie and I had first met.  We put the
collar back on the next morning so we could go to work.  When Charlie got home, he took the collar off, and Petey had an attack almost immediately.  Back on the collar went.  The next day, he peed at least six times without incident (and believe me, we held our breath each time).  The attacks were coming
much less frequently, and didn't seem to be as frenzied.  Maybe it had been just an injury that was bothering him, and the collar and medications were giving him a chance to heal?  After all, he was in the very early adolescent stages, and his privates could have started to poke out and been scratched.  If
that was the case, and the acidic diet was making it more painful when he urinated. We were afraid to even say it out loud, but we were thinking to ourselves "maybe we can beat this thing after all".

     Finally, after a week of 24/7 monitoring, we put Petey back in the main cage with Weezer for the first full night without his collar.  I woke up often to check on him, but he did just fine.  I started to finally breathe a little easier.

     A couple days later, we received a copy of Petey's pathology report.  The following are direct quotes from the report that may be useful to a vet dealing with a similar situation:
His platelets were clumped, but appeared to be in the normal range.
His white blood cell estimate from the smear appears to be 14-20,000.
The following came up on the "differential" --
segmented neutrophils=8%, lymphocytes = 88%, monocytes = 3%, Eosinophils = 1%,
Polychromatophilia = ABN 2+.
Lymphs are small and well differentiated.
Recommend rechecking CBC in the future to rule out chronic lymphocytis leukemia.

     Again, the vet said that the high lymphocyte count (normally less than 40%)could be due to the cortisone in one of his medications.  She suggested that we may want to recheck him down the line if we were still concerned, to see if this had changed.  She suggested we wait at least a month to
do this so he could recover from his illness and rebuild the lost blood that she drew for testing.  We have decided not to pursue additional blood tests unless there is definite medical need, because it would require that he be anesthetized again.  Since he barely made it out from the last time he was put under, we're not willing to risk it.

     We were also told to watch and make sure he was urinating and defecating regularly, as sometimes these injuries can end up causing scar tissue that blocks the bladder or anus.  The glider will seem to be doing fine for a while, then die suddenly about two weeks later.  Thankfully, Petey was as regular as a little clock.

     On September 24, we celebrated passing two weeks with no attacks or problems.  Petey is still alive and well, a happy and healthy glider.  I still can't believe that we got him through it.  I want to stress that two things made the biggest impact in saving Petey's life.
     First, that we were attuned enough to our glider to detect the strange quality in his cry when he first
started biting himself, rather than ignoring it as a spat.  If we'd missed that, he would have probably done enough damage the first night to make it impossible for him to recover.
     Second, we did whatever it took to care for him - the rest of our lives stopped cold, and we spared no expense. He was taken to the vet immediately and as often as necessary, I changed my work schedule and/or took time off to be with him, and we were both willing to miss almost all sleep to stay awake with him 24/7 for a long
stretch of time.   I firmly believe that without both of those things in place, Petey would not be around today.