Two brothers in their early 20s brought in a hardy hamster on this bright morning of Labour Day. The hamster weighs 33 g and has two black ulcerated tumours. One below the chest at 2 cm x 2 cm and the other below the left armpit at 8 mm x 6 mm.
"Why didn't you get the tumour removed when it is small?" I asked.
"We asked a vet and he said to leave it alone," the elder brother said that the tumours were present for around 2 months and could be cancerous. As the hamster exercised, the lower part of the tumour got worn out and became infected and now blackened.
I checked the thin hamster's teeth. He had short teeth indicating that he was still eating to survive.
"He had lost a lot of weight," I said. "He does eat judging by his short front teeth being worn out, but he lost weight due to the stress and the tumours sucking up the nutrients."
The elder brother googled " hamster tumour surgery" or something like that and found Toa Payoh Vets. Now, the hamster is so thin, the anesthetic risk is very high. If he can survive the anaethesia, he would be OK with the chest tumour removed first as the left armpit tumour is large too. There would be insufficient skin to stitch up if both tumours are removed. In any case, the chest tumour can be sliced off in 2 seconds as it is now loose under the skin.
Vets who do not wish to operate on hamster tumours may do the owner a service by referring him to another vet who does it.
Most Singapore owners do not comply with instructions on home treatment of the cat with kidney diseases.
CASE
Fatty, female spayed, 10 years old.
April 29, 2015 Anorexia 3 days. Not drinking 3 days. Diarrhoea (dark chocolate stools) 4 days. Fever 40.5C.
I review the medical records today
HISTORY Feb 2, 2015. Mastectomy. Left mammary gland 1 (MG1) tumour with left axillary lymph node enlarged. Histology - Invasive ductal carcinoma (malignant tumour). Blood test - Urea 5.3 (7.2-10.8), creatinine76 (71-160). No leucocytosis. Platelets low 60 (300-800). However, the cat had been vomiting for the past 2 weeks and the "left" kidney was painful on palpation.
Feb 28, 2015. Vomiting. Treated by Dr Daniel.
Mar 7, 2015 Has vomiting for the past 7 days. Thin but no fever. Kidneys painful on palpation. Blood test - kidneys normal. Urea 7.3 (7.2 - 10.8), creatinine 93 (71-160). Total white cell count 2.3 (5.5 - 19.5). Neutrophils 24% (35-75), Absolute 0.55 (2.5-12.5). Platelets low 78 (300-800).
Tiger Balm ointment smell in apartment. Not to use Tiger Balm ointment which might have been inadvertently rubbed onto the cat.
PRESENT CONSULTATION
Apr 29, 2015 X-rays as kidneys are painful on palpation and enlarged with the cat growling during palpation. Kidneys enlarged No blood or urine tests to reduce medical costs. Given drip + baytril before going home.
Advised dialysis 200 ml Hartmann's Solution/day, next 4 days. Fortekor 5 (1/2 tab/day),, Baytril and Prescription K/D for 5 days.
FOLLOW UP
May 1, 2015 Cat is his normal self. No diarrhoea. Eating the usual Friskie dry food. Did not accept Fortekor and K/D.
CONCLUSION
Although the blood test did not show kidney disorder so far, it is possible that the kidney failure has just started. Probably the cancer cells had gone to the kidneys, causing pain and enlargement. Owing to the need to reduce medical costs, no further are done to check on the kidneys.
I advised crushing the Fortekor dose into 4 portions of powder. Mix with honey and feed the cat. The K/D is to be fed by hand at 5% till 100% or switch to the dry K/D. The owner had given one SC drip. It is difficult to do it. Wrap the towel around the cat to prevent clawing.
In Singapore, this stray cat has no proper home but the cat feeders ensure that she has food and water. "For the past 3 days, she would eat but spit out the canned food," the retiree said to me.
"There could be a fish bone lodged inside the throat," I advised X-rays. Stray cats love fish and some people will feed them with left over fish with bones.
The cat pawed me when I tried to open his mouth. Foul breath. The lower sides of his gums appeared blood red with ulcers. Hence the bad breath.
X-rays showed ulcerated pharynx and proximal oesophagus with gas.
After an anti-inflammatory and antibiotic injection, the cat was active and ravenous and the caregiver is much happier.
Sunday April 25, 2015.
Recurrent eye abscess.
The owner wanted the hamster home on the same day as the treatment of the abscess some 5 weeks ago. She disputed that I had advised her how to do post-discharge care. I had told her verbally to use a cotton bud tip to rub above and below the skin wound to express out the pus, daily. In this way, any residual pus would be let out and the abscess would not recur. She only put eye drops.
This educational video teaches vets how to handle this problem and to prevent the abscess from recurring.
A small skin incision heals too fast if the owner does not express the pus on the second day. There will be pockets of pus still inside the skin. So the abscess recurs. This video shows how an abscess is treated by me at Toa Payoh Vets. Isoflurane + oxygen gas anaesthesia is used here. The whole process of lancing, curetting, irrigating and draining the abscess takes around 5 minutes.
The hamster is OK and will be in-patient for 2 days.
UPDATE
On Day 2, I reviewed this gentle chubby hamster. I expressed more yellow pus from the incision wound. By inching out the residual pus, the wound can heal without another abscess popping out in the next week.
The owner phoned and her male friend came to check the hamster. She asked whether the hamster could go home. I said no. Hamsters are family members and so the lady owner did not want her in-patient but would not want to pay for a recurrent abscess.
POST DISCHARGE NURSING ADVICE IN WRITING.
The vet must let the owners wanting to bring the hamster home on the same day, they will have to bear the responsibility of post-discharge nursing and to pay in full should the hamster recur. This should be in writing to prevent any misunderstanding of the responsibilities of post-discharge care and much unhappiness in having to pay again for treatment.
This hamster stayed 2 nights in-patient and was cleared of pus on Day 3. On Day 2, I could express pus from the closed wound. On Day 3, more pus was expressed although the wound had closed (video). After that, I phoned the owner to bring her home. She should not have any recurring abscess within the next 2 weeks.
Friday Mar 27, 2015
2nd in-patient period at Toa Payoh Vets
Male, not neutered cat, 1.5 years old
Owner wants him to stay another 2 days. He went home after 2 days in-patient during the first visit.
History
Bladder obstruction some 2 weeks ago. The first vet had unblocked the bladder and sent the cat home after 5 days in-patient.
Yet the cat was still passing blood in the urine and had inflamed prepuce. He was not eating and was dehydrated.
The owner consulted me as a 2nd opinion on Mar 17, 2015.
I had palpated much enlarged painful kidneys (X-rays in another video). Therefore, the urethral obstruction blocking the flow of urine, putting back pressure enlarging the kidneys 3-6X and also causing bacterial infection and kidney failure (blood test results of high blood urea nitrogen and creatinine, leucocytosis and neutrophilia from the first vet).
After the first vet sent the cat home, the cat would not eat and it was difficult to give medication orally. Anorexia, tongue and lip ulcers are signs of uraemia as the cat had acute kidney failure. The cat was dehydrated and hypothermia (below 38C). Lethargy. No hope of survival?
This was acute kidney failure due to bacterial infections of the kidneys.
The first vet's clavulox antibiotics and treatment did not eliminate the bacteria. I got a bacterial culture and antibiotic sensitivity test of the urine. The bacteria was resistant to clavulox.
The video shows the cat after 2 days of treatmet at the 2nd in-patient treatment at Toa Payoh Vets
After antibiotics of Baytril, SC fluids of 200 ml for the next 2 days, the kidneys reduced in size (by palpation).The cat was not happy when the kidneys were palpated as there was still nephritis (see video).
CONCLUSION
The enlarged kidneys would be due to the back pressure of the urine from the obstructed bladder. The owner did not know that the cat had difficulty in urination as he shares a common toilet floor with the other 3 cats. The first vet relieved the obstruction and had treated him as an in-patient for 5 days.
This was a gentle cat and so did not claw the vets during fluid therapy. As the family could not accept pork in the prescripition diet, the Royal Canin Renal diet was reported not to contain pork. This was fed to this cat since he went home after the 2nd in-patient treatment.
FOLLOW UP
April 23, 2015
SMS
The owner was contactable by SMS. The cat is back to normal, eating only the Royal Canin Renal food. Normal temperature. So, it is good outcome. This cat is a favourite of the father as this cat meows as if talking to a person whenever he is spoken to. Unlike the other 3 neutered cats in the apartment.
So, he is much loved by the father who told me that he did not want to neuter him as he would become dumb like the other 3 cats.
There is a learning lesson here. Many young Singaporeans do not greet or say good morning to the parents or superior officers. Be communicative and you will be most appreciated by the hand that feeds you or mentors you.
"Your cat has a very low platelet count and liver disorder," I showed the blood test report to the very busy bearded husband who shook my hand as he arrived at 7.25pm to take back his cat.
I know he is very busy. He works in the car parking software field which demands all his waking hours of his life as the various car parks seems to have much bugs, needing his help to resolve the problems. "Your cat has been toxic. He also has pale gums but is now pinker. Did he drink toilet water?"
I had given the cat at least 200 ml of electrolytes, amino acids and antibiotics and the cat meowed when he saw the owner.
"Some cats love to drink from the water splashed or drippinig onto the bathroom floor," I said. The man reflected and thought that this cat could have lapped toilet water.
"I have 6 cats," he said. "The other 5 have no problems."
"It all depends on how much poison the cat drinks and for how long. Why do you have 6 cats? I thought you have only one?"
"The female becomes pregnant and it is against my religion to get an abortion," the husband explained. Fortunately, my relatives have booked a kitten from my latest pregnant cat!"
"Why don't you give some of the 6 cats away?"
"No, no," he replied. "We love them."
I can't understand why he did not neuter or spay the 6 cats. Now one is pregnant again.
