Friday, March 21, 2014

Hyphema in a dwarf hamster in the USA

Mar 22, 2014
Email from a hamster owner in the USA

Hello Dr. Sing,

Thank you for your generosity and willingness to speak with me on the telephone today. I have typed up the history below and attached photographs of my dwarf hamster in this email.


Past medical history:
My pet is a 2-year 3-month old dwarf hamster. His past medical history includes trauma to left eye approximately 1 year ago, which was subsequently prolapsed and was surgically enucleated without complication (Enucleation procedure was performed within 15-20 min, and he recovered within a week), and significant osteoarthritis for which he currently takes oral meloxicam.


Current issue:
For approximately the past 9 months, he has had a worsening cataract in his remaining right-eye. He has been followed by a veterinary ophthalmologist, and based on exam he has had no reflex to light in the remaining eye and is likely blind (although he manages to navigate his habitat quite easily) I've noticed increased vascularization over the past month, and within the past 24 hours, he has developed worsening hyphema of the right eye. The hamster does not appear to be in acute pain or distress, but I've found it difficult to assess pain in a hamster.


I've followed your website for the past year and I noticed that you had posted some pictures on a hamster with bilateral hyphema.

Consultations:
I consulted my veterinary ophthalmologist and small-pets veterinarian today, and they are not certain what the best course of action is at this point. The ophthalmologist recommended diclofenac (NSAID) eye-drops and to see if the condition resolves. The other veterinarian recommended corticosteroid eye-drops. I decided to proceed with the diclofenac 1 drop every 6 hours. The general veterinarian mentioned that because the hyphema is secondary to a long-standing cataract, increased intraocular pressure may be the cause. She mentioned that eye-drops are palliative, but enucleation of the eye would be the ultimate solution. They seems to agree that enucleation of the remaining eye will not affect his vision, because he cannot see out of his remaining eye. However, because of his age, there is an increased risk with anesthesia and surgery. Surgery is scheduled for tomorrow morning.


I wanted to seek your thoughts and opinion on the case of my pet. I am not sure what is the best course of action. My concern is that he may have developed an acute glaucoma secondary his cataract, or that his longstanding eye disease may have led to neovascularization. I am concerned about what will offer him the best quality of life (less pain), and whether enucleation should be the solution at this point. NSAIDs have the risk of increased bleeding, and long term use of corticosteroids can increase intraocular pressure. I am also unsure of the cause of the hyphema, and therefore unsure if the hyphema may acutely worsen, leading to severe pain or prolapse.


I would greatly appreciate you opinion and thoughts. Thank you so much for your help,
Steve

The photographs are attached in this email. The IMG_ named photographs show his eye condition today. The other filenames dated with when they were taken. I will also send you a video I took today in a separate email.

REPLY FROM DR SING DATED MAR 22, 2014
Thank you for your email, images and videos. You have been most caring. My preferred course of action will be enucleation to eliminate the intense pain inside the eyeball. Drugs will not work. Anaesthetic risks are high as the hamster is aged. Best wishes. 



---------------

MARCH 23, 2014 EMAIL TO DR SING
Hi Dr. Sing,

Thank you again for your email and your time. I wanted to provide an update. Surprisingly, this morning I spoke with my veterinary ophthalmologist and took my hamster in to the senior general veterinary surgeon (specializing in exotics). Contrary to the junior vet I spoke to yesterday (who recommended surgery today), the senior operating vet examined my hamster this morning and decided that surgery was not indicated at this time.

The ophthalmologist told me he thought there was a reasonable chance that the hyphema may slowly resolve with diclofenac eye-drops. On pre-operative exam, the senior general veterinarian assessed that he was not in pain severe enough. He mentioned that hamsters usually stop eating when they are in pain, and based on my hamster's activity- he does not appear to be in severe pain. So, we decided to continue with the diclofenac drops, and the general vet added ciprofloxacin eyedrops as well. He recommended follow-up / re-evaluation in 2 weeks.

On my physical exam the hyphema appears to have settled at halfway filled up the anterior chamber of the lens. As of tonight the globe does not appear to be any more prolapsed relative to baseline. I will continue to monitor for any acute changes or worsening.

Are there any other particular signs or symptoms of pain (or specifically eye pain) in hamsters that I should pay attention to? I have read that these pets hide/tolerate their pain quite well, making it somewhat tricky to assess. My ultimate goal is to provide my hamster with the best quality of life.

I realize it's difficult without having examined the hamster, but if you have any input on whether this is a reasonable plan of action, I would love to hear your input.

Lastly, I wanted to thank you again for your generosity and time spent speaking with me yesterday. I truly appreciate it. I also want to add that your website may very well have saved my hamster's life when he had his first enucleation. My local vet who was less experienced had urged a 45min-1hour enucleation procedure, but after reading your website and learning about hamster anesthetic risks, I opted to search the entire city for a vet who had experience operating on exotics. The enucleation was performed swiftly and he concurred that a 45 minute operation would have likely been lethal. I just wanted to let you know that someone across the world was able to benefit from the wealth of information on your website. And not to mention, as a hamster owner, I find the info and pictures to be fascinating as well. Also, please let me know if your animal clinic accepts donations of any sort, as I would be happy to make a small-donation as a token of appreciation for your time.

Thank you again,
Steve


REPLY FROM DR SING DATED MAR 23, 2014

Thank you for your feedback and good news. I always tell my clients that each vet has a different approach to the treatment of diseases and so this results in conflicting advices to the pet owner. There may be more than one way to treat a disease.

In your case, I thought the hamster was suffering great pain and hence advised enucleation. This episode shows that long-distance telephone diagnosis without physical examination is not advised.


Since the hamster is not in pain, then enucleation is not necessary. Generally, frequent rubbing of the eye are signs of painful eyes or inflammation around the eye areas. There will be acute conjunctivitis and hair loss around the upper and lower eyelids.

The best indicator of the hamster's health (and lack of pain) is the number and size of faecal pellets passed per day. If he normally passes 40 large pellets per day for example and now passes less and in smaller sizes, then he is sick. The amount of water drunk per day is another good indicator of health. The owner must be disciplined to monitor 24-hourly and some owners do that.
 
I thank you for your offer of a donation. The service is free to all hamster owners. 
 
Are you an engineer or IT person as you are able to locate my hamster's hyphema images from the internet. How did you do it? 

No comments:

Post a Comment