Friday, March 22, 2013

1337. An 18-gram leg tumour in a dwarf hamster

TOA PAYOH VETS
toapayohvets.com

Date:   07 April, 2013  
 
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
A gigantic 18-g leg tumour in a dwarf hamster
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   07 April, 2013  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

1412. An 18-gram leg tumour

 
Yesterday Mar 22, 2013, I strongly advised the young couple that their one-year-old male white hamster with a large swollen right hind leg with only the foot seen. I said it would unlikely survive the anaesthesia and surgery. The right hind leg was the size of a firm fish ball - the type eaten in fish bowl noodles in Singapore. I got a ruler and show that it measured 3.5 cm x 3.5 cm x 3 cm. The hamster weighed 64 g but he was much heavier some 4 weeks ago.

The couple had consulted Vet 1 who prescribed baytril and prednisolone (pred) for 2 weeks and advised surgery if the drugs were ineffective. Apparently Vet 1 did a biopsy which showed cells were not normal. According to the owner, pus and blood seeped out when Vet 1 put in a needle. A blood test was also done by Vet 1. The details of the procedure were a bit vague.

"Such a large tumour will not disappear with medication," I said. "An early operation without taking medication would give the hamster a higher chance. Pred relieved pain and inflammation but it weakens the immune system and adversely affect surgery. In any case, the hamster is unlikely to survive the anaesthesia as the lump is massive and involves the hip joint as well as the right groin area. If this large leg tumour is removed, the hamster will lose around 20% of his blood and that could be fatal.  The blood supply in this lump has increased to feed the tumour. There is no blood transfusion in the hamster to replace this blood loss as this is not practical.

"This large leg lump would probably be a bone tumour which has spread.   Go home and think about the surgery. The alternative is let the hamster enjoy his life till the lump starts getting infected and bleeding more." However, there was some purplish area and an open wound on the extreme right of the lump. The hamster would lick this lump but the owners had tied a band of tissue paper like a ribbon around his waist, preventing him from attacking this lump.

It appeared that the tissue paper tie was effective but actually it was the pred that stopped the itchiness and pain as the overall appearance of the lump was not highly inflamed or itchy. The hamster would still lick the lump if the paper ribbon tie was taken off.

"Is he still eating?" I asked.
"He eats a lot," the young man said. The young lady showed me a Handphone image of this hamster 4 weeks ago. It was a plump as can be, at 77 grams for a dwarf hamster. So the right leg swelling which would begin as a small tumour was not obvious. 
"He looks thin," I said. "If he is eating a lot, his weight would not have dropped from 77 grams to 64 grams now. How many faecal pellets does he pass out a day? "  
"We don't count them," the young man showed me 2 small faecal pellets in the cage.
I asked the couple to think again as regards the highly risky surgery. "This may be the last time you see the hamster before he goes to the operation room. He will lose around 20% of his blood supply based on this large tumour having cornered this amount, when the whole right hind leg is amputated at the right hip level."
They wanted a few minutes at the reception area to discuss further. 
"Take your time," I had asked them to take 2 days to think about it. This was the type of high risk anaesthesia that I would rather not do. The alternative is let the hamster be euthanased when the tumour had become necrotic and smelly.
"How much time has my hamster to live?" the young man asked.
"Around 4 weeks," I said. "Your medication will have to be taken off as it can't be given for a longer time. It may cause wet tail diarrhoea and the hamster would die from that condition."

It was a hard situation for the owner and for the operating vet. In some cases, I would tell the owner that the condition is inoperable but in this hamster, a right hind leg amputation was operable if the hamster would survive the anaesthesia.

The couple decided on the surgery.

At 6.42 pm I injected 3 drops of zoletil 50 IM. At 7.08 pm, the stitching was done. The hamster was well sedated without the need of isoflurane gas top up. The right hind leg muscles were clamped at the right hip area. I excised the whole leg, cutting off the femoral bone below the hip. I used a transfixing ligature to tie up the muscle remnant. There was no bleeding surprisingly after removal of the clamp and excision of the tumour. I stitched the big skin wound of 5 cm long displaying the right-sided abdominal intestines under the thin peritoneal covering with absorbable 6/0 simple interrupted sutures. 
 
tpvets_logo.jpg (2726 bytes)6078 - 6081. Malignant leg tumour grows more aggressively in younger dwarf hamsters

The hamster was still breathing at the end of the long surgery taking around 26 minutes But he did not bounce back. I phoned the couple who arrived within a few minutes. The hamster was still. Motionless. "Normally I can see chest movements or whisker movements within 30 minutes after surgery," I said to the couple. I checked the hamster's heart. There was no heart beat. The hamster's eyes were open. He had passed away. This was a very sad moment.

The hamster now weighed 45grams. The left hind leg and tumour weighed 18 grams. I expressed my condolences to the owner. It was difficult for them as the alternative was a dehydrated hamster with a necrotic right hind leg. The skin of this hamster was folded up when I pulled it, showing a moderate degree of dehydration.

This type of high risk cases may best be rejected as the chances of survival are very low. In many cases, I don't operate in cases with very low survival rates but this was a younger hamster, being one-year-old and so I agreed to operate at this late stage.

An informed consent was given but at the end of the day, the surgical outcome of death after the surgery was not too emotional for everyone. Yet no operating surgeon can have a 100% no-death surgical and anaesthetic outcome but it still affects the veterinary surgeon.
  
Update will be on this webpage:
www.sinpets.com/F6/20130407malignant_tumour_leg_hamster_toapayohvets.htm

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