Feb 10, 2013. Chinese New Year.
10 am to 1 pm

I opened the clinic for half a day on this Chinese New Year so that I could check on the sick animals, feed and clean up the kennels with my helper. My assistant Min had taken two days off and this would be his last month of work as he had another employer. Singapore is a developed country that is thriving and has low unemployment rates. This leads to employees job-hopping as a norm. The high rentals, manpower and operating costs are common nowadays resulting in businesses that can find difficulties in sustaining their operations. The vet must be hands-on as it is costly to employ more and more inexperienced staff who will job hop after a few months of experience. Other vets poach experienced staff and that is part of life and so loyalty of staff in Singapore is extremely rare in view of low employment rates.  

The phone did not ring throughout the morning of Chinese New Year. I reviewed the severely dehydrated hamster with the ear gangrene and large nose abscesses operated yesterday at 4.30 pm. 17 hours after surgery. Would she be alive? She was less than one year old but from her hagged appearance with leg skin folds raised due to dehydration, I thought she was very aged. "This hamster has very little chance of surviving anaesthesia and surgery as she is barely moving and is severely dehydrated," I told the young lady who brought in this hamster on the eve of Chinese New Year. I lifted up the skin fold from above the neck and the skin fold did not shrink back as is did not have water unlike normal hydrated skin.

"You have two options," I said yesterday. "Euthanasia or surgery with a high possibility of death during or after surgery." The hamster was not eating or drinking as her upper lip was bursting with pus starting from the bridge of the nose towards the upper incisor teeth. In addition, two black gangrenous tumours filled up the right ear pinnae.

"She is less than a year old," the young lady said and picked up her mobile phone to dial. "I will ask my mum what to do." This was the last case on the last day of the old Chinese year and I did not want to end the year with a death of a pet on the operating table.

It was 4 pm and I would close at 5 pm to get ready for the reunion dinner at the Beng Tin Restaurant in Toa Payoh at 8 pm. The mum gave permission to operate.

"Why didn't you get the ear tumours operated by your vet when they were small and not black and gangrenous?" I asked the young lady. "There is now a very high chance of this hamster dying on the operating table."

The lady gave some reasons which related to a previous hamster having been sick and dying soon. "If there are bad news, can you phone us early in the morning on Chinese New Year?"

"No news is good news," I dislike deaths on Chinese New Year and here, there was a very high risk patient that could not wait for surgery as she was downhill in her health, being scarcely awake.

"I will give a 0.1 ml of dextrose saline under the skin now and operate soon." With a heavy heart, my assistant Min and I anaesthesized the hamster using 5% isoflurane gas inside a small plastic container. A few seconds of gas and the hamster was sleepy. I clamped a curved forceps on the right ear after ascertaining that the two gangrenous tumours were adhered to 80%  of the ear pinnae and so there was no alternative but "amputate" the whole ear. After clamping for a few seconds, I sliced off the ear and unclamp the forceps. Surprisingly, there was no bleeding. My joy was short-lived as a large gush of red blood flowed as if a dam had burst. There was a 4-mm gap in the skin where the ear had been cut off and the blood vessels were hemorrhaging a few seconds after ear surgery.

Speed was of the essence in this hamster as she would not survive too many bouts of gas anaesthesia. I incised the two large yellow abscesses above the bridge of the nose. Thick yellow pus seeped out. There was pus at the upper lip which was much swollen. The abscesses seemed to be only on the right side of the nose, as if the hamster had been scratching and scratching over the past weeks to get rid of her painful gangrenous ear tumours. In the process of traumatising the right side of the nose by scratching, bacteria attacked the inside of the skin and formed two big swollen abscesses. This infection spread to the upper lip and it eventually stopped the hamster from being able to eat and drink. Severe dehydration set in.

After draining the abscesses, I decided to stitch up the ear wound and the abscesses with fine 6/0 sutures. The hamster was too weak to object. Two interrupted sutures closed up the ear wound and two closed up the nose wound. I cleaned up the red blood swamping the whole face and neck area. There was nothing more to be done as it is not possible to give an IV drip to such a small animal. A subcutaneous dextrose saline with baytril totalling 0.1 ml was given under the neck skin and I expected no hope of survival.         

So imagine my surprise that the hamster was still alive 17 hours after the surgery when I checked her on Chinese New Year. Not moving but alive. This was a very tough cookie. The water bottle had leaked and the hamster was wet. She had hopped onto the food bowl to avoid the damp litter. Water bottles for hamsters are of poor quality and I had changed several. I quickly dried the hamster and put her on dry towel tissues. I gave her the eye drops as her eyes were shut and the medication orally. 
 

February 11, 2013. Chinese New Year 2nd day.

I opened the clinic from 10 am to 5 pm but I believed most vets closed for the 2nd day. Most Chinese pet owners would not seek out vets unless they had no choice as they would be busy visiting friends and relatives, exchanging Mandarin oranges and the single ones getting ang pows (red packets).  Some vets would be on holidays overseas as they could take 3 days off and get 9 days of holidays as Chinese New Year's Eve started on a Saturday (February 9) and most employees would be off on the following Monday and Tuesday. One vet in Jurong West closed for 7 days and employees would be most happy with such good employers. A pet shop in Toa Payoh closed from February 8 to 15. There was no hunger or need to open during the Chinese New Year holidays for most businesses as employees must be kept happy or they work elsewhere.  

Back to the tough cookie hamster. She was seeping water from the new water bottle for some time. I could hear the "click, click, click" sounds as she put her less swollen upper lips to sip the water. I videoed her drinking from various positions.

This was a good sign that the hamster was recovering well. Yet she seemed to take so many seeps. I checked the water bottle's nozzle. Was there any water coming out? The previous one was licking and this one seemed to be dry. I pressed the ball inside the nozzle and water seeped out onto my fore finger. There was water but there could be a temporary obstruction by the ball inside the nozzle. Finally the hamster had her drink.

I phoned the young lady to take her hamster home. She was most happy that her hamster was still alive. "I have to go visiting relatives and friends," she said she would bring the hamster back on the next day.
 

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A dwarf hamster with generalised ringworm.
On this February 11, 2013, the second day of Chinese New Year, there was another dwarf hamster patient to go home. He had  come in to see me as he was scratching his armpits and shoulder bare of hair. I had given an anti-fungal wash some 4 weeks ago but the hamster was still scratching and so I hospitalised him for clipping and review as there was a ringworm infection. On Chinese New Year's eve in the morning, I went to Chinatown to buy the small hair clipper ($35 battery operated, made in China).  The previous one was not well maintained with cleaning and oiling and had rusted. It is extremely difficult to get employees including associate vets to take good care of the tools of the trade and so scratches on the $7,000 operating table and damages to scopes and the electro surgical equipment were common when used by a particular associate vet and vet assistant. As they don't have to pay for repairs and replacement, why should they bother?

I had this dwarf hamster clipped. He was very well taken care of because he was plump and had a very thick coat of several cm long. He was one and a half years old and he was more active than a 6-month-old dwarf hamster, zipping here and there inside my box. I had to sedate him to let my assistant clipped his thick coat as he would never permit the clipping. I videoed this clipping and the subsequent bathing by me to get rid of as much ringworm on the skin as possible. A few bald spots on his skin could be seen after clipping bald. The European couple loved him very much, especially the lady who could only communicate with me in English via her male friend. I prescribed some anti-fungal medication for 14 days in addition to the twice weekly baths of anti-ringworm solution. The European lady fed the hamster a white cloudy food like yogurt and the hamster licked greedily as if he had been in prison for a long time and deprived of his good food. "What is the food?" I asked. "Cheese," the male friend said. So this was one reason the hamster was so solid and had such a thick coat. Like a panda bear with a thick coat.

"Do you know there are two warts on the right front and back toes of this hamster?" I asked the couple. "They would be viral warts and ought to be removed when they were much smaller. One of them is yellowish as if there is an abscess."  

"They were there for a long time," the man said.
"Now, they are bigger, more than 3 mm in diameter for the front paw tumour," I said. "In time, they would be very big as the hamster licks them."
"Will the hamster die if you remove them (under anaesthesia)?" the lady was most concerned.
"No," I said. "But I would need to remove the whole digit now as they cover most of the digit."
The lady was most distressed as she thought I meant the whole paw would be amputated.
"Think about it," I said. The couple brought the hamster home today and gave me a box of chocolates as a present. Small warts on paws are easily removed but procrastination can lead to large warts necessitating the amputation of the whole digit or paw. As hamsters and people age, some tumours will recur in some of the population. Growing tumours which are not cancerous will take time to expand but it is best to get them excised early.

The 2nd day of Chinese New Year had a few cases of vomiting and diarrhoea in cats and dogs. A dog's nose was cut by the mother's knife. A very sick vomiting old cat was requested to be euthanased. Another cat was suspected to be pregnant as the owner sought advice from Dr Daniel. The owner had told him that he was not happy with a vet who did not know how long is a cat's pregnancy. "It is not easy for a new vet to remember every gestation period of every animal," I said to Dr Daniel. Human medical doctors only need to remember how long it takes a woman to give birth. Vets are supposed to know every animal on earth. 
 

This was the 2nd day of Chinese New Year. I was most happy that two dwarf hamsters had their problems resolved and that I could deliver a service to the satisfaction of two owners, one from the eastern part of Singapore in Changi and the other one from the northern part of Singapore in Woodlands. Referrals come from successful outcomes and these are better than slick advertising strategies.

The above case written 6.13 am, Feb 12, 2013, 3rd day of Chinese New Year.  

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UPDATE ON FEB 21, 2013
The couple accepted my advice to get the two spherical lumps, one present in the right fore paw and one in the left forepaw, amputated. The spherical lumps look like cysts or abscesses and involved the whole digit. So they were amputated as they may have caused irritation and scratching by the hamster. Hamsters and most pets dislike some abnormal lumps or tumours and will scratch or lick or rub trying to get rid of the growths.

This hamster originated from South Russia and was permitted by the AVA to be imported into Singapore, subject to home quarantine. "The hamster becomes much more lively after you clipped off the coat," the Caucasian gentleman said. "Maybe Singapore is just too hot and humid for this thick coat.  Do you provide a service to have his coat clipped regularly?"

He also wanted two areas of white fine hairs to be clipped during amputation of the two toes. "The hamster looks like a hobbit," he showed me two areas of flowing white hairs on each side of the hamster's shoulders in a body of no hair growth. "These are new hairs which grow much quicker than the rest of the body. The skin there may not be infected with ringworm," I advised against clipping them off. He also wanted more ringworm medication to give another 4 days to the hamster as he had given 10 days from the one tablet of 125 mg griseofulvin tablet I had given him. He was to give a small dot of the tablet/day to feed the hamster and this tablet should provide over 100 dots. "Best not to give any more medication," I said. "The hamster's small kidneys and livers may be affected."  

This was a satisfactory outcome as the hamster no longer scratches but the ringworm is not so easily got rid of. He still has to bathe the hamster with the anti-ringworm shampoo.
  
Updates and follow up at webpage
http://www.sinpets.com/F6/20130211hamster_gangrene_ear_abscesses_nose_toapayohvets.htm