Tugger Rat's Tumor and Medical Crisis - JoinRats

Tugger Rat's Tumor and Medical Crisis

Below is my personal story of Tugger's staggering emergency and what it took to give him 3 more months with me.

(My sweet black hoodie, Tugger, is a case on Rat Guide. Caution, if you view the case, the photos are graphic.)

Black hoodie Tugger, before his medical emergency:

Toby, Timmy, Tugger, before Tugger's medical emergency image

In chronological order, the story of Tugger...

Saturday, May 26, Memorial Day weekend.

Tugger started showing signs of pain...
Gave ibuprofen during the day
Fluffy, staying in a box, not playing... quiet in my arms... not moving much...
I can't feel any ouchy spot... I think I saw him squinch his sides in...

Ibuprofen not helping. Switched to expired Metacam. and doxycycline, the only antibiotic I had on hand.

Drat that I can't get him to his vet before Wednesday.

However, with the Metacam. he looks much better, back to even normal looking before I went to bed.


Sunday, May 27

Even with Metacam. this morning, he's back to being fluffy, disheveled, despondent, barely eating. He shows signs of abdominal pain, one can see him twist and stretch as he moves, with a "pinched-in" look to his abdomen near his haunches. No interest in Ensure or baby food.

Email to Pet Rat Enthusiasts, 6:24 p.m.

My Tugger started showing symptoms of pain. At first I thought I saw him 'off' about 8 days ago, but then I thought I was mistaken, he acted fine. Then suddenly yesterday he was in pain:

  • very fluffy, looking disheveled
  • staying in a box instead of coming out to play
  • I thought I saw him twist his lower half. (I've seen that before and it was something intestinal in another rat)
  • I couldn't palpate and detect pain, however
  • I can't feel any lumps
  • I don't hear any respiratory symptoms.

My vet won't be available until Wednesday, and I really don't want to take him to another vet I don't know....
So I've given him ibuprofen which appears to help briefly.
But, I feel he's getting substantially worse, and the thought crossed my mind that at this rate he might die before Wednesday.

He's 20 months old.
He's eating and drinking, but not enthusiastically.

I kept mulling over the fact that I can't find the source of pain, so penis plugs came to mind.
I've never had a boy rat before....
So after reading a bit, I gave it a go with him.
Soaked his underside in very warm cloths (which he liked, because he didn't try to leave the hot soaking material).
Fed him treats.
Then turned him upside down and pressed the way the instructions said.
To my shock it was nearly impossible to extrude his penis. I really had to press, and eventually it somewhat began to pop out.
I believe there is or was a penis plug, I could see the thickish white tip.
However there was also a black substance on the tip, which I've not read about.
Nor have I read what it means that the penis is very difficult to extrude.
He squawked resistance initially but he didn't get more intense as I had to up the intensity of pressure.
And eventually he actually lay there and tolerated it (not sure if he was in shock, though he recovered quickly when we were done).

I managed to moisten off the black bit and the white substance (there was only a smidgen, not the kind of thick plug one sees in pictures), and in my last pressing to do that I saw a drop of blood. Not sure if I caused that, or it's part of what's bothering him.

I assume I need to do this again when he's had a chance to recover, to check again?
I'll also apply a bit of oil when I try, to help his penis get moving on its own again? I didn't have both warm water and oil at the same time.

If anyone has suggestions, I'd greatly appreciate hearing them.
Am I off the mark here?
Have I missed anything, done anything wrong? (For example, I say I had to apply intense pressure but perhaps "intense" is subjective - maybe that's what it takes? I think if I had been that over-intense, he would have screamed, but he didn't react that way).

If it is a penis plug, is the fact that he's feeling pain mean there's an infection that will require AB? He's currently on Zithromycin for almost non-evident respiratory symptoms. Or will getting his penis moving again result in the pain clearing on its own?
If he should see a vet now... what does it mean if I wait until Wednesday?

Thanks, I'm just so relieved I found 'something' rather than nothing...

Email to Pet Rat Enthusiasts, 9:19 p.m.

Right now he's refusing all liquids because of having been syringe fed the Metacam. and Ensure, and then I do have Doxycycline on hand, which I syringe-fed him as well....
I have dried cranberries, not the juice... Do you think a moist dried cranberry would help?
I think he would take that because it's not a liquid coming at him.


Monday, May 28

1:50 p.m.: Raced with Tugger to a friend's house an hour away to get a supply of non-expired Metacam., and Amoxicillin,, because his pain indicates some kind of infection or something much more serious than a penis plug. A second check for penis plugs at the friend's house, and he is fine, no plug.

Email to Tugger's Vet, 3:35 p.m.

Trying to keep Tugger alive - emergency

[In addition to adding all the symptoms described above]

Dr. Harvey, Tugger is coming close to dying and with the help of
friends I've been scrambling to keep him alive.
My plan is to drop the rats off to your office Wednesday morning for you. I so hope you will be there.
It's not clear to me he will make it until Wednesday. :(
If you think someone at the clinic can give him sub-Q fluids on Tuesday, I will bring him in.

[...]

This morning he was back to fluffy, lethargic, not eating or drinking, stretching and twisting, not coming out of his hammock. Friends gave me fresh Amoxi and Metacam, and he got both this morning.

I feel if his pain doesn't get controlled, he may die soon, so I didn't turn down any help.

I also suspect he is becoming, or is, dehydrated. I syringe fed him Boost, and just now, sugar water. My plan is to do that every couple of hours. When I gave him the sugar water he still showed stretching and twisting motions. He also was willing to eat two bits of cooked orzo, but declined more. He looks a little better, as if the Metacam is helping, but his eyes are kind of glazed and distant, and he's extremely subdued.

I have a drop left of probably expired Buprenex and will give that to him at this point, as there's nothing to loose except Tugger himself.

I can't think of what is going on except something very painful internally...

Email to a friend, 9:26 p.m.

His pain has not cleared up. He got less fluffy and disheveled, but he's still contorting and twisting when he moves.
I think he's really serious.
I say this because he chomped down on some orzo but then couldn't sit up to eat it. he kept moving around as if he was trying to sit up, but couldn't. It looks like it's too painful for him to sit upright. He moved into a corner hammock and tried to position himself that way, but finally dropped it and ate a bit with his hands on the floor.
I then took him out and propped him up and he was able to eat 2 bits, but refused the rest.

I gave him a smidgen of the last Buprenex I have. That's made a big difference, he finally calmed and even bruxed comfortably in my hands (instead of being agitated).

I also stumbled upon sealed injectable Baytril years old, with a 7/12 expiration date, and have started him on it..
So he's getting Baytril, Amoxi, Buprenex, and Metacam. And he's just able to rest comfortably.
I'm also giving him a syringe of sugar water with some salt added every two hours.
Thanks so much for your help today, you're helping me help him to his end, I think...
I'm so very sad, he's been a wonderful sweet rat.


Tuesday, May 29

I called into work to say I would not be in.

Email to a friend, 7:19 a.m.

All 3 slept (well, if they slept) in the one level cage on my bed.
Boring for Toby and Timmy.
Tugger was looking pretty good, oddly enough.
I took him out and snuggled on my chest and I hear the monkey noises in his breathing. He was very stressed from the strange cage, I think, and/or from worrying about meds when I took him out.

He wanted back to his normal cage and plunged deeply into a hammock.

Last night when I was going to give a last syringe of fluids, he had monkey noises too. I didn't have the heart to force him. I saw him drinking water so that was good... but not eating...

I still need to do meds this morning.

He's not looking as in pain as I expected him to be... maybe the 1st dose of Baytril helped?

He's going to sound bad when I give him the meds... :(

He had monkey noises yesterday a couple of times for a few seconds, this was worse.


At 8:00 a.m., I called the vet's office and got permission to bring Tugger in for sub-Q fluids.

11:20 a.m. Vet tech verified dehydration and let me give sub-Q fluids to check my technique. They gave me supplies to continue fluids.

Email to Dr. Harvey, 5:27 p.m.

Tugger coming in tomorrow morning.

He was not fluffy this morning and moved around a bit. However, he was still stretching and contorting and had a hard time sitting up to eat. He was hungry for about a teaspoon of 5-grain oatmeal with brown sugar, then declined more.

He was and is making monkey noises at a low level almost constantly and if he gets worried about coming medicine, they increase.

He's been eating little bits every once in a while but just bits. He appears to want to eat but then appears to be unable to eat.

I do still have to force syringe the meds, he's not taking them on his own.

The change this morning was remarkable - he went from a borderline dead rat to an alive rat. I feel like I saved his life.

I withheld the Buprenex to see if he feels as good this evening. If so, I wonder if that says that the Baytril and Amoxi and Metacam. were doing the real job.

He was dehydrated at your office and the tech watched me give him 10 ccs, will do that tonight and tomorrow morning before I bring him in. If you want me to continue him on these meds, I need:

  • New Amoxicillan - what I was given was a bird capsule.
  • The Baytril I have is good through June or July, I guess I can continue to use it.
  • Metacam - I was given doses only through tomorrow morning. If I could take some home from your office and order the smallish bottle on-line, that would be useful to have in stock - I still have about .005 x 2 doses of Buprenex which if you tell me it's technically still good, will be a back-up for this exact type emergency.

Thank you!


Tuesday Evening:

I found something Tugger liked, Trader Joe's Carrot-Ginger soup. Thinking this would be great, to get both fluids and nutrition into him, I allowed him to drink about 2 teaspoons. Unfortunately, this resulted in severe diarrhea that lasted for about 3 hours.

I spent the evening rotating through:

  • Bath for Tugger, running warm water in the sink, washing and re-washing as he stressfully continued with diarrhea.
  • Clean the cage area where he had diarrhea.
  • Forced syringe medication given, which triggered diarrhea again, which required another bath.
  • Cycled through about 8 baths, several syringes of medicines and sugar water, 4 cage cleaning, 4 loads of laundry.

I believe he moved all of the soup out of his system because thankfully there was no diarrhea in the cage or on him the next morning.


Wednesday, May 30

8:00 a.m. I did not give Tugger sub-Q fluids, because he was too stressed by the forced medications.

My plan was to drop off Tugger at the vet's and go into work, but traffic was terrible and so I waited at the vet's for about an hour for the traffic to lighten up. Dr. Harvey was able to see me before I left.

When she wanted x-rays, I decided to stay to see the results. X-rays showed a mass about the size of an index finger to the first knuckle, approximately an inch in diameter, very round in appearance, in his lower abdominal area.

After discussing other testing options, I realized that Tugger was going to die from this, soon. If not from unmanageable pain, then from complications due to the mass, whatever it was. We concluded removing the mass was critical. They were able to clear a space in the schedule that day, and I gave the go-ahead to operate.

I called work to cancel coming in.

About 2:00 p.m. Tugger was operated on, I think, for about 2 hours. He was under anaesthesia for 75 minutes. I think he was in recovery in an incubator for another 2 hours.

Dr. Harvey reported his heart rate stayed steady throughout the surgery, and he recovered excellently.

In addition to AB's, he received fluids. The mass, determined as a tumor of some kind, would be sent out for histology.

My interpretation of what Dr. Harvey did: She removed a mass that was attached to the cecum, a pouch part of the lower intestine which has a dead-end pocket shape.. Imagine a sock shape, with the mass attached inside at the toe. It had grown and pulled the toe inside the sock, pulling it inside out and twisting some of the intestine as a result.

Unfortunately, some of the intestine wall in this area was vulnerable, and leaked bacterial material into his abdominal cavity. Dr. Harvey scrambled to sew up the leakage. She also relocated his entire set of intestines outside his body cavity, and lavaged all the area in order to remove as much bacterial material as possible. She also noticed a part of his upper intestinal wall located near the problem area was affected similarly and showed thinning. Suspecting that it was about to break open, she opted to sew it as well.

This kind of intestinal leaking made Tugger susceptible to often fatal infection.


Dr. Harvey's summary of the surgery:

"Tugger presented today for abdominal pain and anorexia x 3 days. An abdominal mass was palpated. Surgical exploration was elected and revealed an intraluminal mass in the tip of the cecum which had inverted the cecum and caused an intussusception. An incision into the cecum was required to reduce the intussusception. The tip of the cecum, containing the mass, was resected. An adjacent area of the ileal wall had become attenuated and leaked during surgery, so this rent was repaired. Tugger has recovered very well from the anesthetic, but is at risk for sepsis, peritonitis, and obstruction due to the nature of the problem."


I sat with a very sedated Tugger in the reception room for about an hour, until Dr Harvey met with me to review his post-op treatment. I noticed that he was showing signs of pica [the eating of inedible substances], so Dr. Harvey upped his injected Buprenex to try to get his pain under control.

He was willing to drink water and nibble on a grape.

I expressed concern that he had not been bandaged with Lindsay Pulman's style of an anchor-tape bandage, but Dr. Harvey asked me to tolerate him without it because she wanted me to be super alert for any leakage or fluids on the fleece, which would be signs of infection, possible peritonitis, or sepsis.


About 9:30 p.m.

We left the vet clinic and headed home.

Email to a friend, 10:00 p.m.

He has a full plate, doesn't he?
He's on Baytril, Buprenex for pain, and Metronidazole.
He's showing signs of pica with paper so he's assigned fleece only right now. He seems to be tolerating that.
He's eating baby food and yogurt with blueberries and drinking well. He's liking the warming pad under his cage.
He goes in and out of dozing and wandering around looking for paper.


Thursday, May 31

I called into work that I would not be in. Tugger's pain seemed not well managed, based on his continual attempts to gnaw fleece. I spent most of the time holding him.

His agitation caused him to want to groom me, which I let him do. All day long he extensively groomed my face. As I said to a friend, "All my oriface rims are thoroughly groomed." I felt like Dorothy getting a make-over in Emerald City.

He was very good with drinking and eating little bits of foods. He was on a low-fiber diet, to reduce stress to his intestines, so I gave banana, yogurt, scrambled egg, soft tofu, white rice, baby food, rice milk, and watermelon.

He peed regularly, but did not poop.


Friday, June 1

After consulting with Dr. Harvey, I increased his pain med and gave it every 5 hours rather than every 6-8.

Called in to work to say I could not come in.

All day long he seemed to move in and out of feeling better and then not. Eventually I determined this was a need for increased pain medication, which I was becoming adept at determining.

I had seen no leaking or signs of infection.

Email to a friend, 1:33 p.m.

Tugger showed some improvement with pain meds this morning. I would say he's even more improved than yesterday. He appears to need dosing more often, which I will make sure to do from now on.

I've been able to leave his cage door open (he's on my bed) to do things because he's expressed no interest in coming out, but at lunch when I walked in I found him sitting on My bed space, with "Oh Hi Gwen" on his face. He also had a look of, "I don't have any bad thorts about nibbling your mouse cord, no sirree bobtail gwen not me."

That's progress. :)

In the cage, he likes being under fleece and he moved himself and his fleece bundle across the floor to sit next to the bowl of watermelon, so he can poke out his head and get another piece. Very efficient. :)


And then, in the evening, THIRTY HOURS AFTER THE SURGERY:

Email to a friend, 10:46 p.m.

AND WE HAVE POOPs. :)

Whew! 6 nice ones in one 'sitting'. 2 skinny ones and 4 nice plump ones. All well formed and firm! I think the visit with Timmy and Toby may have helped as it got him somewhat excited and active. Tugger looks relieved in more ways than one. :)

I might be more relieved than he is, however. :)

Email from a friend, 10:46 p.m.

"And we have POOPs."

Yay!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Means everything is back to working!!!!! His chances of survival have just increased, Gwen!!!!!!!!!!!!!!!!!!!!!!


Friday evening:

More good poops tonight. Little ones during the day, and then a nice set of 7 good ones in the eve.

More sweetly, I had him snuggled in a lot of fleece and he was extremely relaxed, so much so that he erupted in happy hiccups. Not only hiccups, but Double Hiccups! Not sure if that's a clear idea, to me it means, Not hic-hic-hic, but hic-hic, hic-hic, hic-hic. Lots of doubles in rapid succession. It's always meant more excitement.(I once had a rat do triple hiccups.) These were happy double hiccups.

He has also lessened his intense need to groom me, and seek out salty fluids. Little crumbles of Ritz are golden. I gave him 8 oat flakes for the first time tonight.

He's a big fan of tofu, too. I think I finally have seen him sleep very relaxed sleep instead of drugged sleep (although his pain med is still at .07 every 5-6 hours).

Night!


"Good night" was not meant to be, however.

His feeling better evolved into an interest and annoyance in his stitches. By about 11:45 p.m., when he started in on himself, I realized I would be staying awake most of the night to prevent him from bothering his incision site. Here's the bad rat in action:

Tugger bothers his incision


Despite (or because of?) adequate pain management, he was energetic and a bit agitated and wanted to gnaw his incision site relentlessly. I kept him on my chest where I scritched him and tried to doze myself. When my scritching faltered, he roused himself until I began to scritch again. Eventually he would rouse enough to want to go back to the cage which sat beside us on my bed. He would pee, or eat something, and then begin to groom the incision again. Back to my chest...

Even an additional bit of Buprenex did not lessen his energy.

This cycle repeated until 3:30 a.m., when he finally fell asleep. I got about 3 hours of sleep, and when I woke, he had groomed himself some, but had not had time to do damage to himself.

This rat was not going to sabotage himself after all the hard work some special humans had done!


Saturday, June 2

Fantastic vet visit! Tugger gets an A for his current physical state.

However, the histology was back and it was cancer. It appeared that the margins were clean, but there were some strange cells outside the margin which may or may not be cancerous. The cancer type is slow-growing. So, there's a slim chance he is cancer free, but an excellent chance he has many months left, and will live to an old age.

He was not out of the woods for peritonitis, but he showed no signs of any abdominal infection.

Another week to watch for infection.

However, at my request, Dr. Harvey's vet tech bandaged Tugger. This was to control his incessant incision bothering, but perhaps more importantly, to let me sleep.

As is my usual pattern, I stayed with a wrapped up Tugger in the waiting room, to see how he would do. Within about 15 minutes he had slipped backwards outside the bandage as if he was oily.

Back to the vet tech about 45 minutes later, and he was re-wrapped. This one appeared to have a chance of staying on.

At home he was severely stressed by the bandage but I hoped he would become accustomed to it.

It stayed on. I got some sleep.


Sunday, June 3

Email to a friend, 7:08 a.m.

Tugger's bandage lasts one night, Gwen gets sleep :)

Ohhhhh boy he's a mad rat.
He shredded a lot of his floor fleece last night and stuffed the loose fleece into the food and water bowls.
But he made it through the night with the bandage intact.
Gwen got 6 hours of sleep. :)

When I got him out this morning and gave meds and foods and soy milk, he bruxed and boggled and fell asleep in a big piece of fleece which I set at my feet (on the bed).

I saw the fleece moving around, being pushed here and there. I checked and he was cleaning his face, and then trying to get comfortable.
So I finished up bits of chores and then his head poked out --
a--nd -- and --
out walked a non-bandaged rat.
{shakes head in amazement}.
He had again slid it over his head and off.

I set him in the cage where he happily ate, drank, and groomed himself.
He studiously ignored me despite my efforts to entice him to interact, and is now asleep.
That's totally fair!


Over the following 2 days Tugger was very agitated and stressed from the bandage experience.

I assessed that he would no longer bother his incision site so made no attempt to re-bandage him.

During the following week I allowed him small visits in the big cage with his buddies, which excited him to no end. He clearly wanted more free time and became more agitated at being confined in the small cage on my bed.

I was able to return to work on Monday and Tugger's pain remained basically managed.


Tuesday, June 5

Email update to Dr. Harvey, 9:29 a.m.

Tugger update, worried and including request for Baytril/Doxy.

I think he is doing well, I think.
I realized I never palpated his incision area and should have, because now that I have tried it, I feel a lot of thick area - which I hope is scar tissue forming, but could it be fluid swelling?
It appears generally more enlarged - the entire incision length as well as the bit at the end that is like a knob.
Should I be worried?

He also got very stressed from the bandage and spent two days making monkey noises. He stayed in the bandage just the first night, which was enough to get me some sleep. He slipped out in the morning and acted like he was in shock for a day.

The monkey noises return with medication time, and sometimes I heard ongoing softer breathing sounds when he's excited or mildly stressed.

Given that he was making the monkey noises the first day I got him, when you saw him and heard him and put him on Baytril, and now that he's older and going through this kind of stress, could I request that you put him on both Baytril and doxy? I will be out of Baytril by Friday.

I realize I am asking you to treat him when you don't hear the noises yourself, but my understanding is that this is generally how it works for upper respiratory symptoms, including that they can come and go.


Dr. Harvey called me to reassure me he should stay on the meds he is on. I will see her on Friday for another follow-up visit.


Friday, June 8

Email to friend.

How the Friday vet visit went

Tugger got an A!
I would say A+ except he has a bit of fluid that she says is normal, and the end of the suture line has a bit of a reaction (also just swelling you can see), which is normal as it dissolves into his body.
He is free to go back to rat stuff!
However, he could overdo it (he already did that once, I could see), which in practical terms means he would just be sore. He can't do any internal damage at this point.

So last night I let him into the main cage, no restrictions, after we go home about 7 p.m. Then I crashed and woke up at 10:30 to hear Toby SQUAWKKK!!, which is what he does normally. I could see Tugger playing with him. Not wanting Tugger to over-do, he came back my bedcage for the night. But this morning he is in the main cage for the day because he will mostly sleep. He looks great, feels great, is clearly a HAPPY rat.

Pain meds will continue because he shows he is sore without them. I'm very good at dosing. We are continuing Baytril and Doxy for another month. The metronidazole stops as of tomorrow.

I am so HAPPY to know he is home with his best buds. :)

FANTASTIC UPDATE, June 16, 2012:

Tugger is doing fantastic. He is still on Baytril to counter lingering respiratory symptoms, but no other medications. He is spunky, exploratory, happy. I see he is a little hesitant to fully launch into rat play, but hopefully time will heal.


Tugger TugBug Rat and Dr. Carolynn Harvey, DVM:

Dr. Harvey and Tugger


Tugger's healing incision on Friday, 6/8/12:

Tugger's healed incision


A feeling better Tugger starts up with happy touble-making:

Dr. Harvey and Tugger too

image

September 2, 2012, three months later

The final chapter. Tugger had begun to decline and I was giving him sub-Q fluids and very strong pain medication. But the decline was permanent.

Email to Dr. Harvey

He died this morning about 6:55 am.

I knew he was near the end, so I spent all day yesterday holding him (which he sought out). He positioned himself so that his whiskers touched my face. He wanted my hand around his head, stroking his forehead and shoulders. If I lost this focus, he nudged me or himself into me to regain my attention.

At 11:30 pm he made it really clear he wanted to go into the hospital cage with the others. They were staying there just for this purpose. So I let him and set my clock for 3 am. He was asleep but when I woke him he made a beeline to me, and it was clear he was near the end.

He spent 3 am to 6:55 slowing dying, but peacefully (it seemed to me).

He died on my chest as I held him, quietly, softly.

I loved him very much.

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