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Date:   18 October, 2011  

Focus:
 Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Unacceptable veterinary advices
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
18 October, 2011
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

"When the hamster's tumour starts to bleed, bring her to me and I will put her to sleep, Vet 1 advised us," the mother brought her teenaged daughter and her hamster to me today 11.30 am, Friday Oct 7, 2011. "I consulted Vet 1 three days ago and my daughter has been crying since."

Vet 1 had said that the dwarf hamster, being 2 years old, would die under anaesthesia and surgery. Therefore, wait till her abdominal tumour bleeds, to bring the hamster in to be euthanased. The mother could have surfed the internet and phoned me.

dwarf hamster, 2 years, female, zoletil, large subcutaneous tumour, toapayohvets, singapore"It is not a guarantee that all dwarf hamsters with tumours will die under general anaesthesia," I don't understand why Vet 1 would not have asked the owner to see other vets if Vet 1 would not perform surgery. I just rejected a koi owner who phoned up to ask if I treat kois. It is the right thing to do and is in the interest of the animal. Not to advise waiting till the tumour bleeds and bring the hamster down for euthanasia.

"Much depends on the health of the hamster, the size of the tumour and the duration of anaesthesia," I happened to pick up the phone today as I was in the Surgery to interview a job applicant who wanted to work with animals and teach 3 Temasek Polytechnic volunteers on cases involving an old Maltese with cystitis, a stray cat with FIV and a puppy on an IV drip, amongst other pets.

"How big is the tumour and is it a breast tumour?" I asked. The mum did not know and spoke to the daughter. "It is best I examine the hamster."

"How much is the consultation fee?"

"$30.00," I said. "But you already had consulted Vet 1. The decision should be whether you would want to take the risk of this old hamster being operated and pay the operation and anaesthetic fee.

"If the hamster survives the operation, she lives another 6 months as dwarf hamsters live up to 2.5 years of age. If she is not operated, the tumour gets infected and bleeds as the hamster keeps nibbling it. Lots of blood stains and great distress for your daughter in the next few days, leading ultimately to death by lethal injection. In such cases, your daughter would be much traumatised after seeing the hamster suffer from bleeding all day long!"

It is extremely difficult to be a mother of young teenagers nowadays. I could see that the slim fair 14-year-old was from an elite school. The cream of the crop, now much distracted by her hamster's poor health. She did not know when the tumour developed and so whether it was fast-growing or not, it was difficult to say .

"My daughter has her examinations till Monday," the mother said. I could sympathise with her as she wanted her daughter to excel in the highly competitive academic environment. How could she revise her lessons when she cried daily as her beloved hamster had no hope of survival?

As a veterinarian, the best interest of the pet must be priority. If the vet cannot handle a case, refer to other vets or ask the owner to find another vet.
dwarf hamster, 2 years, male, zoletil, large subcutaneous tumour, toapayohvets, singapore I don't treat birds and fishes and I don't accept such pets in the first place.

The dwarf hamster is old at 2 years of age, but she is full of energy. Weighed 36 gram and has an excellent appetite. Trying to escape when the cage door is lifted up. Big black eyes. Well endowed.

"The chances of surviving anaesthesia are 70%," I said to the mother who had asked if I provided services to euthanase the hamster to prevent pain and suffering.

"Did you hear that?" the mum asked the quiet girl.
"Quite a good chance of survival," I said.
"You had operated on hamster tumours?" she asked.
"Yes," I said.

dwarf hamster, 2 years, male, zoletil, large subcutaneous tumour, toapayohvets, singaporeThe 3 Temasek Poly students, Dr Vanessa, Mr Min and I attended to the dwarf hamster. "This is a case where Zoletil sedation is needed as isoflurane + oxygen gas will not give you sufficient time to excise and stitch up in less than 5 minutes."

I said to Dr Vanessa, "With Zoletil sedation, you have around 5 minutes of surgical anaesthesia to complete the surgery. But you can top up with isoflurane gas." I told Mr Min to switch on the gas, just in case.

"All the theories of dosage per kg in vet books are not applicable usually in the real practice," I said to the 3 students - a young man and two young ladies. "This dwarf hamster weighs 36 g. How many ml of Zoletil to give without killing her? This is why many vets all over the world do not like to anaesthesize hamsters. The safety range is very narrow."

I got the Zoletil ready. Two one-ml syringes were placed on the table. Mr Min got me a 23G needle which I told him was inappropriate. Dr Vanessa got the 25G needles from the consultation room.

A person learns by doing and making mistakes. No other way. I asked Dr Vanessa to get 2 drops of Zoletil from the first syringe of Zoletil held by Mr Min. She got 2 drops. This would not even fill up 0.01 ml of the syringe. "Add normal saline 0.05 ml," I said. "Just a little bit."
She did it. Overall, the amount was less than 0.05 ml.

The students watched in silence as Dr Vanessa adjusted the drug inside the syringe. She pushed up the plunger up a bit. Suddenly a spray of anaesthetic shot out from the needle as she had not contained all at one lower end, if you know what I am talking about.

The students kept silent. Nobody dared to laugh as I am the serious type when it comes to training and surgery. I guessed the students were astonished.

"We have to start all over again," I said to Dr Vanessa. "Use a new syringe." This time I adjusted the drug content inside the syringe and then asked Dr Vanessa to inject the hamster IM.

"Inject IM?," Dr Vanessa said I should do it. I understand. This dwarf hamster has no bulky backside muscles like the dog or cat or even a rabbit.

I stretched out the hamster's left hind leg while Min held the front body. I pointed the 25G needle at the appropriate backside and injected. I have a big bandaged right hand but I could still do the injection.

"If the hamster does not go groggy within 1 minute of injection," I said to the students, "It means the dosage was insufficient or that I had not injected directly into the muscle."

The students were very silent. Within 60 seconds, the dwarf hamster went down on her side. "You have less than 5 minutes to complete the excision of the tumour without isoflurane gas," I said to Dr Vanessa. Everything has been prepared for her.

I handed her the scalpel. She nicked the tumour for 0.8 mm long, undermined, clamped and used the scalpel to excise off the lump. The hamster moved a bit as the anaesthesia was lighter.

It is extremely difficult to get the ideal dosage without causing death as the hamster is so small," I said to one student who later commented that the hamster had moved during the stitching up. "This high anaesthetic risk is the reason why many vets do not want to do surgery to remove big tumours."

The 3 students had a rare opportunity to see the whole process from pre-op to post-op.
 

TIPS FOR VETS

Sometimes it may be wise to pass up a case rather than to offer unacceptable veterinary advices as they do stress out the hamster owner and force her family members or mother to seek another opinion.

If you add value to the hamster owner by offering alternative advices other than unacceptable advices, you may retain the goodwill and that is good for you.
 


The above case study took 57 minutes to create. National Library Board (NLB) Victoria Street, 5.12 pm, Oct 7, 2011

Something wrong with the NLB computer, 8th floor. The text automatically became so small as to be unreadable. So, had to stop writing. The time taken to write the above was 57 minutes!

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All rights reserved. Revised: October 18, 2011

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