R.I.P Derrick

Hello again, readers,
Firstly, I wanted to add in a brief section to say that I started writing this post with the belief that Derrick was going to make a full recovery. Before Derrick passed away, he had been battling kidney disease and/or failure alongside a persistent UTI (urinary tract infection). I've decided to post a singular blog post with minimal amendments about both Derrick's tremendous battle with his health, and his passing. I appreciate that there will be a lot of information crammed into the one post, but I believe it will show a true representation about the entire process. With that being said, I won't say any more on the matter and will let you get on with reading the post.
This post will include a section about what happened prior to medical investigation, and a section about the medical investigation itself.
We will break it all down into clearly labelled sections to make it easier for you to pick out the bits you'd prefer to read:

Part One - The Misjudgment:

Mistakes happen, and we've certainly made our fair share! We do believe that it is nothing to be ashamed of and we're quite happy to discuss many of them openly. Mistakes are often just a great way to learn a lesson in life; lessons will keep repeating themselves until learned. 

For those of you who don't know, Derrick was a neutered buck who lived within a mischief which also included 4 does (Leia, Nima, Nova, and Shmi) - 5 rats in total. The group certainly had it's ups and downs, but it worked. Things started to change within the mischief, the atmosphere seemed fairly unsettled. We'd began to notice a few more disagreements and squabbles within the group.
One day during free roam time, we discovered Leia with a worrying number of scratches. We had already noticed a bit of bickering between Leia and Derrick beforehand - it wasn't just that singular event. We decided it would've been best to take Leia out from the group. With tensions being so high, we assumed she must've been the problem. 
 *The fur loss is from a previous surgery*
Leia isn't an easy rat to live with, she loves companionship, but on her terms - she makes it very clear when she wants to be left alone. On the other hand, Derrick was a very cuddly and playful soul who craved companionship, but to put it bluntly, it was always his-way or the highway. The two of them were either yin and yang, or mortal enemies.   
We'd hoped that separating the pair of them would've resolved the issue (but if you read the subtitle we're sure you've already figured out that we were wrong).

We were quite 'lucky', with Leia being a spayed female, she could live with more or less who ever suited her best. Our next plan would've been to introduce Leia to one of our other neutered bucks - Rowan. We chose Rowan because of his incredibly placid and laid back nature. The only downside to our plan; Rowan already lived with our other pre-existing mischief which consisted of a neutered buck (Rowan) and entire bucks (Alfie, Arthur, Travis, and Trevor). 
Although, our plan fell apart pretty quickly once Rowan became ill with a suspected infection (which later turned out to be a mini-stroke) around about the time this all happened - we've done a previous post on the subject. We felt it wasn't fair to cause Rowan any unnecessary stress which could've potentially made him worse. He was already settled within his mischief, we just wanted to leave him be at this point.

Simultaneously whilst the Rowan-situation was taking place, we'd noticed that Derrick's mischief hadn't exactly settled down either - we assumed it was due to all of the multiple recent changes at first. A few more days went by and things only got increasingly heated between some of the rats in Derrick's mischief. It all came to a head, and we then witnessed Derrick turn on all of his friends. We had to intervene in a fight which quickly turned nasty. It was at this point we realised that it wasn't Leia who was the problem; it was Derrick. 

We then decided it was within all of the rats best interest for Derrick to be separated from the mischief (we introduced Leia back to the other does as well). 
We racked our brains as to what could've been the cause behind all of the sudden mayhem. We thought one of the only things that had changed which could've been behind Derrick starting to 'randomly' attack his cage mates, was having recently taken on a mischief which included entire bucks.

Side note:

Derrick came to us after being brutally bullied by his brother - Dennis. The pair were kept within a small enclosure and never separated despite the vicious attacks (which appeared to be fairly one-sided). Subsequently, Derrick was left with very severe psychological and physical trauma. Derrick had to be neutered in the end, whenever he was around bucks he had a I'm-going-to-hurt-you-before-you-hurt-me attitude. We put this down to being a learned defensive behaviour which had stemmed from the previous abuse from his brother. It took us around 6 months before we successfully bonded Derrick to our existing mischief of does. We've previously written a couple of posts (1)(2) on the subject on our blog before. 
This is also the reason why we initially chose to remove Leia from the mischief and not Derrick.

Back on topic:

So, we assumed Derrick's aggression may have been because he could smell the entire bucks - leading to him becoming quite distressed. We rearranged all of the cages to drastically increase the distance between each mischief. We also scrubbed the cages clean in case there was any dominance scent marks. Afterwards, we made an attempt to hopefully bond all of the rats back together again. 
At first, the bonding process all seemed perfect, but it was too good to be true. Within a 24 hour period Derrick instigated yet another seemingly unprovoked attack which very nearly caused significant injuries to one of his cage mates. We managed to intervene in time, no injuries were inflicted (apart from a bite-wound to my index finger). 

Derrick was acting completely out of character - to the point that he was barely even himself anymore. We decided it was time to contact the vet (who is conveniently an experienced rat owner) to ask them for some advice. We feared there was a medical reason behind his behavior. 

Part Two - Medical Investigation:

Derrick was admitted for some medical testing as the vet was concerned Derrick's behaviour could've linked to pain. We wanted to share this great bit of reliable information which helps demonstrate some signs of pain in rats:

The vet noticed Derrick was particularly distressed when being touched around his back end. This finding enabled the vet to perform appropriate urinalysis tests to check for any underlying UTI, kidney/liver failure/damage, diabetes and his hydration status. The test  tragically revealed off the chart levels of blood in Derrick's urine.
The vet explained that there can be multiple causes for the blood in urine, but it would be sensible to rule out some of the more serious causes first - kidney stones being one. The vet took X-Ray radiography of Derrick. Thankfully, the radiograph was useful in helping the vets to rule out any large stones. We were warned about possibly needing some lateral X-Rays in the future but they weren't required at the time.
The next, and most common, cause for the presence of blood in urine: a UTI (which can make rats quite nasty). Derrick was sent home with some Enrofloxacin/Baytril and some Canine Meloxicam/Metacam (NSAIDS) to help ease the pain. The vet said we could introduce Tramadol (opiod pain relief) if Derrick was still in a great deal of discomfort. He was also to be housed alone during this period for the safety of the other rats. Later, he did unfortunately require the use of Tramadol (we discontinued the Metacam at this point). 

Derrick did show some response to the medication, however, this was put down to the Tramadol controlling the pain, more than the Baytril helping the bacterial infection. Although, he was still vocalising and visibly uncomfortable.
So, Derrick went back to the vets again for some further tests. Another urinalysis revealed some blood was still present in his urine. The problem was did appear to be some-what better, but he was by no means 'cured'.
The vet believed it was appropriate to have further radiographs taken at this point. He was admitted again for the lateral X-Ray radiograph to be taken which we mentioned prior. This was to see if there were any smaller stones which had gone undetected. Derrick also had a blood sample taken for analysis.
Luckily, Derrick's results were unremarkable. The vet believed we were probably dealing with a bit of resilience to the Baytril, especially with the drug commonly being associated with the prescribing cascade. The vet discontinued the Baytril and introduced him to a longer course of a different antibiotic. This time, they trialed Derrick on Kesium (Amoxicillin) tablets alongside the Tramadol and also re-introduced the Metacam as well to help try and control Derrick's pain levels.

Sadly, Derrick still showed no response. Our vet was becoming increasingly concerned and so were we. The vet decided to contact a couple of exotic specialists in order to help decide what would be the most suitable next course of action. It is always useful to have multiple sets of eyes looking over a particular case - seeing someone else's perspective only broadens your horizons. 
Our vet had three 'most-likely theories' at this point: a resistance to the antibioitcs, an internal bladder tumour, or idiopathic cystitis (the less likely theory). They wondered if it was worth doing a culture sample, or would it be worth doing an exploration surgery due to the level of Derrick's discomfort. By now, he'd also been living alone for a month - less than ideal, but necessary nonetheless. The specialists then decided it would've been most appropriate to send of a culture sample to the microbiologists before putting Derrick through unnecessary invasive surgery - we were happy to oblige.
We collected the urine sample at home - we felt as though we were holding liquid gold!

The culture sample came back with some fairly interesting results, we will post them for those who're interested in reading them to save me typing it all up:
Given the results of the culture sample, the vet decided to trial Derrick on a long course of Trimoxazole (antibiotic) alongside the Tramadol and Metacam.

Remarkably, Derrick appeared as though completely transformed around us, we were able to stroke and handle him without him screaming. In fact, we even slowly tapered off the Tramadol, and eventually the Metacam during the course too.
When the time came for Derrick to give another urine sample, we couldn't wait to get the results from the urinalysis - we all had our hopes up for Derrick to recieve the all clear.
Heartrendingly, that moment never came. Derrick still had off the chart levels of blood present in his urine. 
The vet decided that the most suitable move would be to send off a blood sample in order to determine Derrick's kidney function. They also re-introduced the Tramadol (a safer form of pain relief to Metacam if kidneys are affected) and Derrick remained on Trimoxazole for a persistent infection.
Derrick’s interpretation:

Haematology demonstrates a marked leucopaenia which may reflect sequestration

of leucocytes at an inflammatory/necrotic focus. There is also a moderate to

marked hyperproteinemia consistent with dehydration and/or increase in the

globulin fraction due to underlying infectious, immune mediated or neoplastic


It was very concerning how low Derrick's white blood cell count was. Our vet feared Derrick could've had bladder or kidney cancer which was been sapping his white blood cells. With that being said, the vet decided it'd be worth conversing with the vet at the lab as well to see what they would recommend given the results.

The vet at the lab recommended a cytology examination on a urine sample with there being a concern for bladder or kidney cancer. A cytology examination could tell us if there were any cancerous cells within Derrick's urine coming from his bladder.
We decided to go for it, we needed to find out where in his body his white blood cells were targeting - especially with there being so many concerning symptoms and hypotheses.

Eventually, the cytology results came through and were able to rule out any form of neoplasia. Although, another full urinalysis was recommended. We will enclose the results for those who're interested:
Whilst waiting for the results, Derrick had been rapidly getting worse. We contacted the vet and dropped off another urine sample. Urinalysis was still revealing off the charts levels of blood and protein in Derrick's urine. The vet explained regrettably all they could do at this point is up the opioids. Realistically, that still would've done very little. Evidence shows that opioids usage for chronic pain typically isn't all that great. 

We were then faced with that extremely difficult decision that we ever never wanted to make - humane euthanasia. The multitude of testing revealed that Derrick had a persistent UTI that he couldn't fight without the help of Trimoxazole due to having no white blood cells in his blood to fight the infection. Derrick's white blood cells were basically being sapped by his likely Kidney Disease and/or failure. There was nothing else we could've done other than attempt to manage the symptoms, which we simply were no longer able to do at this point. 
We did temporarily manage some of his symptoms with the help of Tramadol and changes to Derrick's diet (we used Rat Ration's No. 8 Elderly and Kidney Friendly with egg biscuit w/o garlic). Unfortunately, Derrick had to be housed in solitude during the end of his life due to uncontrolled levels of aggression towards other rats (he was already neutered and living with does). We were left with absolutely no other options. Derrick's health was irretrievable and if left, he would've been reduced to deplorable living standards.

I can say that with complete confidence Derrick's passing was very peaceful. There was not a dry eye in the room when saying goodbye to our very special soldier. I was with him all the way until Derrick's last breath - he then gently slipped away.

Derrick passed away on 16th August 2018.
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