dont know what to do with my miserable rat

Question
Hello -
I come to you in desperate need of advice.  One of my boys has been plagued with upper respiratory problems for the past year.  In June, our vet said he had pneumonia, and his survival chances were 50/50.  He was started on Zithromax, and in August the vet had a listen and said his lungs sounded great, no Rales, no wheezing, etc.  His breathing is still very laboured.  Vet took an x-ray, which showed nothing abnormal.  There was very faint circular patterns on his lungs, barely detectable, that she said were probably lung scarring.  She said there is nothing to be done to ease his breathing.  He is on the Zithromax long-term, and while he seems URI free, his breathing is so laboured I can hardly stand to watch.  He is active.  He eats, he gets good, restful sleep. He just gets so tired so quickly, and I know it isn't comfortable for him.  Compared to his healthy brother, he breathes about three times as fast, and sleeps/lays around three times as much.  

To add to this, he also itches like he's on fire.  He and his brother have been treated for mites with Revolution, in addition to Ectokyl spray around the room, and general washing of their cage and toys.  They eat Reggie Rat mix, or pick at it anyway, along with grapes and apple in the morning, and peas or carrots in the evening.  They're both picky eaters, and I'm trying so hard to keep weight on my sick boy, he breathes so fast that weight melts off almost as quickly as he can put it on, so sometimes if all he is willing to eat is scrambled eggs, I let him have them.  But during the times when I have cut out the extra protein I haven't seen any change in the itching.  I took them off the Carefresh bedding for a while when he was sickest, as the vet said it would help him not to be on dusty bedding.  They really liked living on shredded newspaper and soft towels (changed daily), but I wondered if the laundry detergent I use or perhaps the ink on the newsprint was causing him to itch, so as he's gotten better I moved back to the Carefresh.  The room also has a humidifier, so I don't think it's a dry skin issue, especially since he didn't have this problem last summer.

All to no avail.  His daily routine consists of waking up, grinding his teeth like a maniac for a minute or two, then scratching and grooming for ten or fifteen minutes.  He'll eat a bit of food, roam around for ten or fifteen minutes, then retreat to his igloo to scratch some more then lie down and pant until he falls asleep.  Repeat.  He's had a complete personality overhaul and is obviously uncomfortable.  

The vet insists there is nothing to be done for his breathing.  Steroids are not an option, she says, and the only antibiotic she knows to have him on is the Zithromax (she seems to think he doesn't respond so well to Baytril and Doxy).  The Revolution has failed twice now (two treatments consisting of three doses for each rat, two weeks apart), and now she just shrugs and says "the itching might just be a constant thing, ya know?"  

Should I be pushing her to do more in terms of diagnostics, or try a new vet?  This is the only local that treats exotics and I was told they were very good.  Or am I supposed to just except this poor quality of life for my little boy?  I feel terrible for him.  He is obviously not at the point where he is ready to give up on life; I have always been told that as long as he eats and drinks and sleeps and bullies his brother, he is still interested in living.

I know this isn't really a direct question, more a series of long drawn out question like things.  But any advice you might give me would be dearly appreciated.  I have a feeling that my boy could have a chance to feel better, if I just knew where to start and what to do.

Answer

Few things first:  has he ever been on baytril or has it only been zithromax?

Why does the vet feel this is strictly myco related and not a secondary infection?  
To be honest, he should be on baytril and amoxil for secondary infection, but since he has not been treated properly chances are his lungs may be scarred by now from not being treated correctly.

Why are steroids NOT an option?  Does the vet not understand that this could help his breathing tremendously? Steroids help with inflammation of the lung tissues in humans with severe cases of pneumonia and even for those with COPD?   Is the vet worried that the steroids would compromise the immune system?  If she is, she is not considering the fact that the benefits outweigh the risks for starters and also if the rat is on the right antibiotics, any potential infection would quickly be dissolved. Last but not least, does the vet understand that the rats metabolic rate is so fast it eats through medications like fire burns through dry field, in turn, lowering the risks of side effects to the point that unless the rat is going to be on the steroids for 6 months, no side effects will even be seen.  

To me, I would start your little guy on brand new meds, two different antibiotics that will work to compliment each other.  Something for inflammation, something to open his airways such as albuterol and also if you can get your hands on a nebulizer, this would be fantastic.

To be honest, I have my doubts about her credentials in exotics.  There are only 100 certified avian/exotic Vets in the entire world and more vets that claim to be an exotic vet are simply general vets that see dogs and cats and pocket pets as a special interest.  If she were truly a board certified exotic vet, she would have given your rat much better options.

I suggest another opinion and soon. If you need my help I would happily give you names of vets in your area that WILL be willing to exhaust all options rather than allow him to simply have to settle for what she is willing to do for him, which is not much in my opinion.

Many vets that see exotics as a special interest and are not certfied avian/exotic vets are very good with rats and go the extra mile keeping up to date on treatments by attending workshops and conferences/seminars etc....  so dont get me wrong when I say that they need to see strictly certified avian/exotic specialists.  However, your rat needs more treatment as you already seem to be aware of.   I would go for another vet.  Let me know your location and if you want to make this private I can check out the vets credentials you are seeing now. I am curious as to how much of an exotic vet she really is. I am not impressed.

I want to help.  Your little guy deserves much better.
As for the extensive itching, has the vet tried ivermectin?  Have they seen and identified the ectoparasites on the rats and do they know what type of mite it is, such as tropical rat mite, for example?