Edgar and Zee

This rescue, in particular, has both a heartwarming and heartbreaking side to the story - depending on which rat we talk about. We will discuss Zee's happy story first and finish with Edgar's tragic life story.

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Arrival:

Edgar and Zee arrived as two young buck brothers. They were approximately 8-12 months old when they arrived. Other than a parasitic infestation, the brothers were in good overall health. The infestation was treated with accurately dosed spot-on Ivermectin (antihelmintic).

Zee:

Zee is a button-pusher. He loves to stir the pot between the dominant bucks within his mischief. Karma eventually catches up with Zee, but he is always foolish enough to push his luck again.

Neutering:

As we've mentioned, Zee likes to wind up the tougher bucks (not something we'd recommend). Zee learned his lesson the hard way. Remember, when you play with fire, you're only going to get burnt.

Zee and Chucky (now castrated) had an argument which accidentally caused Zee to end up with a laceration to his scrotum, leading to one of his testicles becoming exposed.

We booked Zee in for an emergency castration as the risk of infection was substantial. Fortunately, the surgery went smoothly. Zee's home accommodation was adapted to help reduce the risk of further injuries and infection. He was also given adequate pain relief to alleviate pain and inflammation.

Zee's surgery is a thing of the past now, although he is still a mischievous rat at heart. He lives within a mischief which includes over 10 bucks, and they all love him exactly as he is - 99% of the time. He also gets plenty of human love too.

Edgar:

Edgar was a playful and giddy character. We rarely feel 'robbed' when dealing with death. To put it bluntly, it's quite naive to take on a pet rat when unable to deal with death. We're not suggesting that it doesn't hurt, or that you may not cry, but you must be prepared to process death. A rat's lifespan is roughly 2 years - it's coming if you want it to, or not. On the other hand, Edgar passing away at such a young age felt unfair and undeserved. Anyone who met him would soon be smiling from ear to ear over his childish antics and hilarious behaviour. 

Despite his young age, Edgar was far from soft or weak. He was a fighter with a lot of strength and will to live. Sadly, the odds were against him, and after months of battling, Edgar's fight was over. 

Neutering:

Edgar started to present signs of hormonal aggression. We decided it'd be beneficial to have him castrated. Our vet agreed to perform an orchiectomy on Edgar, so he was booked in for surgery.

Fortunately, the surgery was a success and Edgar came round from the anesthesia. He was introduced to QD 1mg:1kg Metacam and his accommodation was adapted to reduce the risk of injury and infection post-surgery.

Blocked Parotid Salivary Gland:

Edgar quickly developed a unilateral swelling on the side of his face. We believed it was a Zymbals gland tumour. 

Zymbals gland tumours are neoplasms that form on, or from the fatty auditory sebaceous gland located at the anterior and posterior aspect of the ear canal and beneath the squamous epithelium. The bilateral glands are adjacent to the auditory canal and made up of numerous lobules of modified sebaceous glands. 

Sebaceous glands are glands which secrete an oily matter known as sebum. The morphology of the Zymbals gland is typical of other sebaceous glands, with a typical microscopic appearance, holocrine process, and size. The function of the Zymbals gland remains unknown.

Growths of the Zymbals gland can be nonneoplastic or neoplastic, adenomas or adenocarcinomas which can be determined with a histology report. Adenomas are benign tumours of glandular tissue, whereas adenocarcinomas are loosely the malignant 'counterparts' to adenomas. More often than not, neoplasms of the Zymbals gland are malignant in rats. Most carcinoma tumours are only locally invasive, but some malignant ZGTs can metastasize to the lungs.

Before we could discuss 'treatment' for Edgar, we decided it would be best to perform a fine needle aspiration to get a clearer picture as to what the growth was. The FNA results confirmed there were no abscess or cystic properties, but was fairly inconclusive as no particular cells were aspirated. Unfortunately, Edgar was likely dealing with a ZGT.

In most cases, ZGT carcinomas are impossible to remove given their location and consistency, and as necrosis is often prevalent, debulking the tumour usually isn't an option either. 

Our vet advised that we turn to management and palliative care. Edgar was demonstrating signs of pain, so we initially introduced him to Metacam/Meloxicam (NSAID), but his pain persisted. Our vet then advised we introduce Edgar to a high QD dose of oral Prednisolone (corticosteroid) after a flush-out of non-steroidals. Steroids were much more beneficial for Edgar.

As time progressed, Edgar's 'tumour' started to behave differently from what we'd typically expect. The growth had started to shrink and became odorous. This was suggestive of a blocked gland, likely the Parotid salivary gland, rather than a ZGT. 

The previous FNA didn't aspirate any pus, ruling out cysts and abscesses. FNAs can only detect a limited number of cells and materials, meaning a confirmed diagnosis of a ZGT could only be given if those particular tumour cells were aspirated.

The Zymbals gland is located outside the external ear canal, whereas the parotid salivary gland is located behind and below the ear, caudally bordering the submandibular gland. Differentiating between the two based on sight alone would be near impossible.

Fortunately, although it was a misdiagnosis, management of the two would've been identical. Once the blocked gland had cleared, we gradually started to wean Edgar off corticosteroids.

Inner-Ear Infection and Abscess:

Edgar suffered considerable weight loss (was 400g instead of usual 505g), he'd developed a foul odor within the right ear (same side as blocked gland), was walking in circles, had poor balance and coordination (could be due to vertigo), and was showing signs of pain - possible ear and/or jaw ache.

At the time, Edgar was in the process of being weaned off Prednisolone, which meant Metacam was off-limits (using non-steroidals and corticosteroids can have severe negative consequences). Instead, he was introduced to Tramadol (narcotic opioid) to help alleviate pain levels. As we suspected Edgar had an inner-ear infection, he was introduced to Baytril/Enrofloxacin (fluoroquinolone antimicrobial agent). Edgar could've developed an abscess deep within his ear canal, direct surgical-treatment for an abscess would've been strongly discouraged, so medicinal management was prudent. Permanent vestibular impairment and infection spreading to the brain were also possibilities.

Despite input from numerous exotic specialists, we were unlikely to ever fully determine the chronological or anatomical order in which Edgar's health issues developed. 

Edgar developed signs of nausea shortly after he was introduced to the new medication. He was introduced to Ranitidine (a synthetic compound with an antihistamine - Histamine - 2/H2 - properties) to combat sickness. We also increased Prednisolone QD again.

Edgar was admitted for an ear flush, medication revision, and for radiographs. Edgar failed to respond to the current care plan and recently developed anorexia.

Ear flush cleared 'waxy' odorous build-up.

Edgar's X-rays didn't show any obvious changes to the bones. By now, Edgar had become anorexic and would only drink very watered down WUB. He had assisted bottle feeds every 2 hours. Edgar was refusing to eat due to severe ear and jaw pain.

Unfortunately, due to becoming incredibly weak and vulnerable, Edgar had to be housed alone, he did, however, frequently have monitored playtimes with his friends.

Edgar had been prescribed oral Baytril. Baytril can be administered both orally and parenterally. Enteral routes enter the systemic circulation, but systemic delivery of therapeutics on any route faces numerous challenges. The drug must be able to bind to the target to induce the intended biological effect. The blood labyrinth barrier presents more challenges for therapeutics to be delivered to the inner ear.

We debated swapping to Noroclav: an antibiotic containing Amoxicillin and Clavulanic acid,  but we were likely to encounter the same issue.

Instead, it was our last hope and a bit of a long shot, we decided to swap to a Baytril and Dexamethasone (corticosteroid) topical suspension. We used a non-invasive approach to hopefully combat the difficulties we'd been facing. Topical drug administration comes under parenteral routes for systemic circulation, however, systemic absorption depends on the site, skin condition, and drug(s) used.

Initially, we thought the new approach had worked. Edgar had a couple of unassisted soft food meals. Unfortunately, it wasn't the case. A few nights later, he had significant neurological abnormalities; including ataxia and decreased brain function. It was likely Edgar's inner-ear infection had now spread to the brain and possibly the tissue around the brain signaling possible meningitis. 

Edgar's time was up. We decided to opt for humane euthanasia and requested a post-mortem for the following day.

Edgar passed away on 22nd April 2019.

WARNING: GRAPHIC AND DISTRESSING CONTENT!

Upon post-mortem, Edgar's middle ear cavity was filled with pus which extended to the brain - the brain is in close contact with the middle and inner ear structures. Without a radical bulla osteotomy, his illness was not treatable. Given the involvement of the brain, surgery was not an option.