Alisaie's Congestive Heart Failure - Full Write-Up
Alisaie had a lot of health complications since she arrived here with us, so much so, she ended up being given sanctuary-status. She came into our care as a family friend could no longer care for their hamster due to unforeseen circumstances. We were happy to take Alisaie on.
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Health Complications:
Primary Incisor Overgrowth:
When Alisaie arrived, we noticed she was quite slim and appeared to be unable to fully close her mouth. When giving her a thorough health check, we discovered her incisors were overgrown.
Dental diseases aren't uncommon in pet rodents as they have hypselodont incisors and molars in both their upper and lower jaws - their teeth are constantly growing and require continuous effective wearing. In fact, you'll notice that, to a degree, many mammals are revealed by their teeth. The word "rodent" comes from the Latin word "rodere" which translates as "to gnaw".
Dental disorders can be either primary or secondary, depending on the cause. Alisaie's dental issue was the consequence of an inherited skeletal malocclusion. As Alisaie's mandible jaw was too short, only her incisors were affected and maloccluded. Malocclusion refers to an incorrect relation between the teeth of two dental arches as they approach each other when the jaw closes.
Alisaie's incisor overgrowth was managed with monthly incisor-burring under inhalant anesthesia.
Open Pyometra and Ovariohysterectomy:
Alisaie developed an odorous vaginal discharge which is often suggestive of an open pyometra: a uterine infection where the cervix is open, allowing discharge to freely flow from the body. As Alisaie was otherwise well within herself, the vet wanted to trial oral Baytril/Enrofloxacin: a broad-spectrum fluoroquinolone antimicrobial agent, to help treat an underlying infection before opting for major surgery. She was also introduced to QD oral 1mg:1kg dosage of Metacam/Meloxicam: a non-steroidal anti-inflammatory. After a week-course of antibiotics, no improvements were seen. Us and the vet decided it was appropriate to go ahead and perform a spay/ovariohysterectomy.
Alisaie handled the GA brilliantly and was discharged from the veterinary practice the same day. She continued with her antibiotic course for an additional week, and she was supported with adequate pain relief too. Hamsters are particularly sensitive to the effects of antibiotics, whether administered orally or by injection. Despite numerous studies highlighting the limitations of probiotic usage, we decided it wouldn't be counterproductive to use them whilst Alisaie was on antibiotics. Antibiotics are incredibly helpful, but they do also cause major changes to the balance of gut bacteria.
Probiotics contain live microorganisms such as 'friendly' bacterias and yeasts and can aid treatment for some illnesses, such as diarrhea, vaginal yeast infections, and more. They usually work by promoting healthy digestion and a healthy immune system. However, probiotics are regulated similarly to food, rather than medication. This means that some probiotics don't have to prove they're safe or beneficial.
During the initial stages of recovery, Alisaie was housed in an adapted accommodation to help reduce the risk of injury and infection.
Alisaie recovered well from her surgery.
Fully healed surgical site
Amyloidosis and secondary Congestive Heart Failure:
Alisaie presented with some concerning symptoms. She had audible respiration, although her lungs sounded fairly clear when auscultated, and she had a hunched posture which was suggestive of pain. We introduced her to Metacam 1mg:1kg QD - no improvements were seen.
Video showing symptoms.
Our vet recommended admitting Alisaie for clinical investigations and radiographs and trialing her on Frusemide/Furosemide (loop diuretic) in case she was in heart failure. The inhalant anesthesia would be riskier, but X-Rays could provide useful insight.
Right Lateral X-Ray view.
Firstly, Alisaie handled the inhalant anesthesia dreadfully and was gasping/mouth-breathing for a while once she had awoken.
Secondly, once we'd obtained her X-Rays, they revealed an enlarged heart and fluid in the lungs. This was suggestive of Amyloidosis and secondary congestive heart failure, and her positive response to diuretics further coincided with the diagnosis.
Amyloidosis describes an abnormal build-up of a protein called Amyloid in tissues and organs. As a result, it affects their shape and how they work. Amyloidosis is also a known cause of CHF. Several studies have shown female Syrian hamsters have a distinct predisposition to acquire Amyloidosis with aging. Other studies further suggest the female protein 'p component homologue' is of primary importance in the disposition of Amyloid.
Congestive heart failure (CHF) doesn't refer to a heart that has 'stopped working', it simply means that the heart works less effectively. In Alisaie's case, her heart worked less effectively due to the build-up of Amyloid. CHF is a long-term condition that usually progressively worsens, it cannot be cured but can be managed for some time.
Alisaie was introduced to Frusemide BID. Furosemide is a powerful loop diuretic and it can be used to treat pulmonary congestion due to heart failure.
Video showing improvements 24hrs after initial administration.
Alongside medicinal management, given the negative reaction to anesthesia, we decided to perform Alisaie's dentals every 6-8wks, rather than every 4wks.
We managed Alisaie's quality of life for a long time. Sadly, however, Alisaie had newly developing brief and infrequent episodes of cyanosis: the bluish cast to the tissues near the skin surface which occurs due to low oxygen saturation.
Cyanosis is a medical emergency. If the episodes of cyanosis were due to hypoxia (abnormally low blood oxygen levels), then catastrophic organ failure and brain death can set in within minutes - depending on the severity of oxygen deficiency or deprivation. Consequences of true hypoxia can be instantaneous.
It was clear Alisaie's condition had started to take its a toll on her wellbeing, with the episodes of cyanosis becoming more frequent, and with nothing else we could do, we decided it was necessary to have Alisaie humanely euthanized.
Alisaie enjoyed some carrot cake on her final night with us.
Alisaie passed away on 17th June 2019.
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