Leia - Full Write-Up

Hello again, readers,

We can only apologise for the amount of inactivity on our blog recently. We try our hardest to stay active on social media, but sometimes it's challenging - we've had a busy few months. We always ensure our animal's care (and our sanity) is prioritized over social media. Our blog is a pretty big time consumer, we try to put so much research, thought, and planning into each post to try and provide our readers with high-quality content. However, we are aiming to get a few posts out soon!

This is the post we've found ourselves putting off for a while. I personally couldn't find the words to express my despair for losing Leia - truthfully, I still can't. Partly because she'd been through so much throughout her little life, and partly because it still hurts as much today as it did on the day when she passed away. As you're probably aware, generally, I prefer my write-ups to be more 'informal'. I decided to write this post from the heart; we will see where it takes us:

WARNING: THIS POST CONTAINS SOME GRAPHIC MEDICAL CONTENT AND IMAGES WHICH SOME READERS MAY FIND DISTRESSING.

This post is meant to be informative to readers about one of our resident's lives and some of the approaches we took. It should not be used to substitute medical advice from your own qualified medical professional.

Leia's arrival:

Leia arrived alongside her Mum, Padme, after being approached by Hamster Haven (rescue) asking if we would consider taking on two does in need of an experienced home. After losing our initial duo of does, we decided to accept the offer from Vicky at Hamster Haven. The girls needed an experienced home due to them being manx/tailless rats.

Manx rats:

Manx rats are still to this daily considered fairly controversial within the rat community. The total absence of the tail is considered to be a true genetic mutation; it's quite complex, but based upon my basic knowledge of genetics, it's not considered to be a simple recessive gene such as other genes. There is research to suggest that the manx mutation may even be polygenetic - requiring more than one activated gene to express a manx.

The reason Manx are so controversial, particularly within the breeding community, is because of the lack of a tail; though aesthetically pleasing, it can be considered as a deformity. The extent of disability can vary drastically between individuals. 

Side effects from the mutation can include the following:

• difficulty walking
• difficulty climbing
• skeletal abnormalities (most commonly regarding pelvis and rear legs)
• inability to balance 
• sensitivities to temperature
• bladder problems
• bowel problems
• fused back legs
• dysfunctional back legs due to the malformed skeleton 
• stub tails
• spina bifida
• birthing problems with does

Needless to say, there is most definitely an argument for it to be considered unethical to deliberately breed such rats. Although, Padme and Leia didn't have significant levels of disability due to the mutation. Both girls had difficulties with advanced climbing (ropes etc), minor bladder problems, an inability to balance, and minor walking abnormalities: the does appeared to waddle. We were able to accommodate their needs with simple lifestyle adaptions e.g. shelving in cages, hammocks, cleaning their back ends etc. 
We do not agree with deliberately breeding manx rats as pets.
Leia was a baby at heart, she didn't particularly like fuss from anyone apart from both her Mums (yes, I was one of her Mums). Padme's (Leia's birth Mum) passing definitely changed mine and Leia's bond. I actually felt extremely guilty for not being able to save Padme at the time. I knew she was everything to Leia, so when Padme was no longer around, I definitely took over her role. 
During free roam time, she would often come waddling over to me to escape from her ratty friends for a little bit of alone time with her Mum. She loved sitting in my lap and having her head fiercely stoked, but not as much as she loved red berry malt paste! 

Particularly during her later life, Leia had an ever-expanding list of health problems. Whenever she was ill, I felt my parental and nurturing side to our bond strengthen. I genuinely believe she knew I was there, and would always be there to help her. She knew the medications helped alleviate her suffering and improved her quality of life, and that was enough for her to be a star patient (towards the end).

Leia's Health:

Surgery one (removing mammary tumours):

It started with 3 mammary tumours and a URI (upper respiratory infection). We ensured Leia's respiratory infection had cleared up with a course antibiotics before she had her first surgery to remove the 3 mammary tumours - little did we know that she would go on to be known as a "tumour factory" between us and our vet.

The surgery was a triumphant success and Leia appeared to take the anaesthetic in her stride. Recovery was, unfortunately, less smooth. We initially avoided using a cone to prevent her from unnecessary stress and further injuries that can occur. Back then, we'd also never used one before, so we were wary. Instead, we kept Leia in solitude whilst wearing a body-wrap to prevent her from both direct and indirect damage to her post-op surgical wounds. 

Unfortunately, that plan failed pretty quickly. Leia managed to worm her way out of the wrap multiple times and had to be reglued/stitched a few times as well. Shortly after, Leia sadly developed a bacterial infection at one of the surgery sites.

After being flushed out (you could consider this as her second procedure), the wound then had to heal from the inside outwards; delaying the recovery process. We aided her recovery with the use of antibiotics, a non-steroidal, and topical Flamazine cream. During this delayed healing process, Padme tragically passed away at approximately 2.5 years old. 

After a few weeks of recovery, Leia was able to go back to her friend - Shmi. A few months later, she even made friends with a neutered buck called Derrick.

The exotic specialist also believed Leia was susceptible to mammary tumours due to her having three develop in such a short space of time - it may even have been a form of neoplastic disease. They decided to introduce her to Resveratrol (stilbenoid) and Celecoxib (NSAID) indefinitely to help prevent them from reoccurring. If that didn't work, a spay/hysterectomy was also advised.

Surgery two (hysterectomy due to a Pyometra and a mammary tumour removal):

Initially, it was unclear why Leia was suddenly uncomfortable, she was slightly bloated as well as demonstrating signs of pain on occasion. Our vet decided with the symptoms being somewhat vague, that an ultrasound scan may have highlighted some abnormalities that could've gone undetected. No abnormalities were found. Our vet made a rare decision and sent Leia home with no treatment; at that point, nothing warranted it. However, we were told to monitor her extremely closely; if anything changed, then she was to go straight back. We understood that intervening when it isn't necessary can sometimes do more harm than good.

Within a few days, Leia started with a bloody vaginal discharge. This was a major red flag and could've meant that Leia had something as resolvable as a UTI (urinary tract infection), or something as life-threatening as a Pyometra (uterine infection: can be open or closed). Her bloat and pain levels had also worsened. An emergency X-Ray was taken to see if anything could've been picked up that the ultrasound could've missed.

Thankfully, the X-Ray showed nothing of major concern. We didn't want to put Leia through any unnecessary surgery because of her age at the time. So, we decided to try her on antibiotics. She was introduced to a course Baytril/Enrofloxacin: a hard-hitting antibiotic which is particularly useful against mycoplasma infections. This was supported with a non-steroidal; Metacam/Meloxicam which helps alleviate inflammation and pain levels. We hoped this would control any underlying UTI. If Leia worsened, she would've required an emergency hysterectomy for a potential Pyometra.

If you saw the mini heading, I'm sure you've already predicted that Leia did, in fact, worsen - rapidly. We were given the opportunity to have some swabs taken of the discharge in order to determine if there was any antibiotic resistance, but the exotic specialist didn't believe we could've done much else in terms of management. The only other and most sensible option was to go ahead and remove Leia's uterus. It was also essential that this was done sooner rather than later due to the speed Leia had been worsening; the sicker she became, the more high risk the surgery became. We booked her in for an emergency spay.

The day came, and during Leia's pre-op assessment, our vet discovered yet another small mammary tumour. We opted to have it removed under the same anaesthetic. Having a spay would've actually helped prevent the tumours from reoccurring - silver linings.

Just like the first surgery, Leia handled the hysterectomy brilliantly - possibly because she was initially pumped full of pills. For the first few days, Leia continued with Baytril/Enrofloxacin (antibiotic) and Metacam//Meloxicam (NSAID), she was also introduced to Tramadol Hydrochloride (opioid). 

We did also learn from our first recovery experience with Leia; we couldn't risk her removing stitches with a hysterectomy. It was undoubtedly necessary to restrict Leia with a post-surgical recovery cone to prevent her from causing serious damage to herself. She was also housed in specific hospital accommodation to help reduce the risk of injury and infection. 

Leia's healing process was much smoother this time; there were no complications what so ever. She went on to make two new friends - Nima and Nova.

Surgery three (lancing large abscess):

Leia generally wasn't in 'perfect' health for very long. We always knew something else would've popped up eventually. This time, it was an abscess - one of the largest abscesses we had personally ever seen on a rat. Initially, we tried to treat the abscess with Kesium/Amoxicillin: an antibiotic which is particularly useful when treating skin infections. She was also introduced to Baytril/Enrofloxacin (antibiotic). The abscess remained persistent and foul-smelling. Leia had a general anaesthetic so the abscess could be surgically lanced. The minor procedure was successful. She was to continue with her antibiotics and needed the surgical wound bathing twice daily with normal saline. She also had to be housed in specific hospital accommodation during this period to reduce the risk of injury and infection.

As you can see, the recovery was fairly long, graphic, but smooth nonetheless. Leia never did grow fur back in some areas, the abscess likely destroyed some of the hair follicles; her quality of life was not affected by this. She went on to meet a new friend - Maz.

Development of a chronic respiratory disease (likely pathogenic mycoplasma pulmonis):

Chronic respiratory diseases are common amongst pet rodents. If you follow our Instagram, you'll be quite familiar with the topic. We have had approximately 10 rats (probably more) to date with a form of chronic respiratory disease - varying in severity. 

Leia was mainly affected by her upper airways. Unfortunately, most chronic respiratory diseases cannot be cured, but can often be managed. We tried multiple different approaches; different administrations of respiratory drugs, an array of different medications, and prophylactics.

When Leia's symptoms first began to present themselves, we were actually experimenting with Shmi's medications for a CRD too. Leia's main symptom was audible respiration (able to be heard without auscultation with a stethoscope). Her case was certainly mild, but normally the disease worsens, or you experience relapses as time progresses and the rat/patient ages - in our experience.

Initially, we trialled Leia with nebulised F10 (ready to use) for its antibacterial properties, Bisolvan (mucolytic) alongside strict prophylactics (preventative healthcare). The approach was unsuccessful for many reasons. The biggest flaw with the first approach was actually the administration; nebulising works by turning some medications into a form of breathable mist which is then inhaled into the lungs, it's a more direct approach than other forms of therapy. Nebulising generally targets the lower airways more than the upper airways. Another problem is the levels of stress that can occur when nebulising animals. Minimalizing stress is one of the prophylactics we consider paramount to managing respiratory diseases. Some animals handle nebulising better than others, we generally find most rodents cope quite well. Leia, however, did not. We decided with the input of our veterinarian that oral medications would've been more beneficial moving forward.

Leia was also introduced to Corvental: a bronchodilator containing Theophylline. Ph. Eur to help dilate the bronchi and bronchioles which therefore decreases resistance in respiratory airways. As a result, this should increase airflow to the lungs. There are different forms of bronchodilators, as mentioned, Corvental contains Theophylline. It is unclear exactly how Theophylline works, but it is believed to decrease swelling of the airways. Leia also used an NSAID (non-steroidal anti-inflammatory drug): Metacam/Meloxicam. It's very self-explanatory, but non-steroidals will reduce inflammation and work solely on the inflammatory pathways, unlike steroids. 

Unfortunately, Leia's symptoms persisted. Our vet made the decision to swap the non-steroidal to an oral corticosteroid: Prednisolone (converts to prednisone). One of the major drawbacks to this decision was that Leia would have to stop the Celebrex/Celecoxib (used for prevention of mammary tumours) as it is a non-steroidal. Non-steroidals and steroids cannot be used in combination due to the severe side effects which may occur. Steroids also mimic cortisol production (they're the man-made version of the hormones naturally produced by the body - normally by the adrenal glands, to be precise) and put the patient's body into stress. 
Think of it this way: true chronic stress has a really negative impact on your body. Cortisol is widely known as the "stress hormone". Something that occurs when stressed is elevated cortisol production - often it occurs in a response to fear to trigger the fight or flight response. It can extremely damaging long-term. Elevated cortisol production is known to increase cholesterol, lower immune function, interfere with learning and memory, it can even shorten your life expectancy - and that's only the beginning. Of course, steroids do undoubtedly have their place in medicine, for a wide range of things in fact, and short-term they can be beneficial; this was one of those places.
Our vet went ahead with the decision because, at the time, Leia's health concern was a chronic respiratory disease, not mammary tumours - she was also spayed which helps decrease the occurrence of mammary tumours - she also continued with Resveratrol. Due to the intermittently audible respiration, our vet also introduced Leia to Doxycycline/Ronaxan and Baytril/Enrofloxacin to be used in combination to help combat a pathogenic mycoplasma upper- respiratory infection.

Development of Osteoarthritis, Sciatica, and Hind-Leg Degeneration (HLD):

This is where things started to get more complicated, we began juggling medications in order to create a balance in managing all of Leia's health conditions.

The diagnosis came about when Leia was continuing to lose weight, was showing no response to the steroids (after being taken off non-steroidals), and for some peculiar reason, her movements seemed to worsen with the change in respiratory medications (swapping to steroids).

As we've already discussed, Leia did walk with more of a 'waddle' anyway due to her manx mutation. When the medication was changed, Leia walked with more of a pivot and was putting less weight through her back-left leg. We decided to have the vet re-examine her and see if we needed to shake-up her medication-cocktail a little more. Upon clinical examination, our vet could see the problem. Due to her manx mutation, and her age at the time (approx 2-2.5 years), our vet believed Leia may have started suffering from the beginning of osteoarthritis and/or sciatica, and HLD.

Sadly, the conditions Leia was diagnosed with are nearly always degenerative, and often age-related, disorders. Management of the conditions often includes medicinal treatment and lifestyle adaptations. Leia wasn't the best climber to start with, but we ensured everything she needed (safe litter, food, water, general enrichment) was on a single level. We made sure to also keep Leia as active as possible for as long as possible, we kept playtime fun, frequent (but shorter to avoid over-exertion), and safe. We helped her with daily activities such as grooming (wiping genitalia and anus after using the litter tray and nail clips etc) and eating (soft foods). As she was also struggling to keep her weight up now due to less efficient food utilization, we introduced her to high-calorie WUB with added plain oats, ground maintenance diet, and honey.
Medicinal management included swapping Leia back to non-steroidals due to her having no benefit from the steroids. It is likely that the 'flare up' was due to there being less pain-relief in Prednisolone than Meloxicam. The other benefit of swapping Leia back to a non-steroidal was that we could re-introduce Leia to her specialist preventative medication again for mammary tumours: Celebrex/Celecoxib.

Surgery four (removing mammary tumours):

Yep, there were more tumours! We initially only noticed one tumour that had developed in her 'armpit'. It was tiny, but if it grew (highly likely), then it wouldn't have taken long before it completely immobilised Leia, especially given her pre-existing conditions - resulting in humane euthanasia being the kindest option.

Or, though high risk, we could've had the tumours removed. They were free moving and our vet believed they would've been easily removed. We decided that it was the best thing for Leia to have them removed - she was a fighter. we knew she could pull through.

Leia was a model patient throughout her healing process. She wasn't introduced to any new medications due to already being on the appropriate drugs for other health complications. Her recovery was quick and smooth, and she healed wonderfully. She went on to meet 8 new friends - Amelia, Amidala, Cinnamon, Debora, Mabel, Nella, Pandora, and Xander.

Surgery five (removing mammary tumours):

Leia made a full recovery from her previous surgery, she was fully healed and back with her new group of friends. She was loving life, so it was great to see that we had made the right decision. The following day, we devastatingly discovered yet another tumour. This tumour was in more or less the same place as one of the tumours that had just been removed. We were slightly apprehensive about continuing to put Leia through major surgery. This time, we decided it could just be the worst case of 'bad luck' (we hate saying that). Two of the does that we had recently taken on also required surgery to remove mammary tumours, so the three of them were all booked in for surgery on the same day.

All three surgeries were a success and all the does came out of recovery brilliantly. We decided to use Leia's surgery-recovery-wisdom to help Nella and Xander through their first recovery. The three of them were housed in hospital accommodation together, it really helped alleviate some of the stress that unavoidably occurs post-surgery. The girls were all introduced to necessary medication.

Leia was a phenomenal influence on Nella and Xander throughout the entire process. We were so proud of her. It was truly beautiful to see Leia demonstrate the same motherly instinct that Padme had always showed her before she passed.

All of the does made a full recovery and healed beautifully. Leia was a true soldier. 

Development of a mammary tumour and decision against operating:

Leia recovered from her second surgery within a short space of time. All seemed well, and then once again, we discovered yet another tumour. We contacted our vet once again, and we had a serious ethical dilemma: Do we operate? Or don't we?

We came to a mutual decision; with there being such a high probability that she would just continue to grow more tumours, and already having pre-existing health complications: HLD, Osteoarthritis, a chronic respiratory disease, and a manx mutation, that it would be far more humane on Leia to live out the remainder of her elderly life without chasing tumours with surgery. We could rest easy knowing we'd taken all the necessary preventative steps; a spay, specialist preventative medication, and diet amendments. The prophylactics definitely enhanced Leia's quality of life, but in some cases, the tumours are still unmanageable.

Leia's passing:

We decided not to operate on Leia on the 22nd August 2018, and on the 31st August 2018, she passed away. Before she passed away, she seemed to have a widespread flare-up of her health conditions. Her pain from her osteoarthritis had increased, her HLD was more significant, and her respiration was noticeably more audible. We contacted our vet and discussed if it may be necessary to introduce her to Tramadol (opioid), even if it were short-term. We had come to an agreement that it would be worth a try. We went and created a suspension mix to ensure she had a suitable dose of the painkiller. When the syringe was fully prepped for oral administration, we went to get Leia out of her cage in order to administer the drug. As I held Leia, she quickly and effortlessly slipped away into her forever sleep. I was in a state of disbelief, which was then followed by floods of tears. However, now that some time has passed, I am so grateful that Leia passed away in the comfort of her own home surrounded by those who loved her.

Leia's life was packed full of adventure (hence why the post is so long). Hopefully, by having all of her health battles within the one post, you will see how resilient and strong she really was. Obviously, there was much more to Leia than her health complications, she was also the sweetest and most lovable little rat. Everyone who had the pleasure of meeting her saw that unique character that made her so special. She is deeply missed.

Good night, Leia. 

31st August 2018

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A huge thank you to our wonderful veterinarian, Sarah Bruce, for taking such good care of our special Leia.