Post Op Seromas

Question
QUESTION: Hello
 
my 2 1/2 yr old rat had surgery to remove mammary tumors on Monday.
this was her 3rd surgery in the last 6 months ( one -2 mammary gland * one small armpit seroma that resolved,  3 months later one left adrenal medulla tumor removed,
and this surgery the vet took 3 mammary tumors out)
two were quite large- grape size,  we had to wait 3 weeks to give her max recovery from the adrenal surgery.  None are cancer.

at day 3 post op we starting to notice a seroma developing
day 4 two  seromas  with some blue discoloring were there getting bigger-
    original vet is out till monday-  and 90 mins away
    local vet saw and said to watch
day 6  one has stabilized if not started to go down
the other- over her hip/leg where one of the surgery sites is
has gotten slowly bigger overnight again  
we have been watching her 24/7 since surgery and keeping her from getting at the sutures and trying to keep her from over  grooming with that back leg.

she has been so itchy that every time she is not sleeping she was scratching her face and neck
some times almost frantically
that most likely did not help anything,  but she is a rat and already very angry that she is not allowed in her 4 story cage  -  and it being bothered every time she tries to do anything.

we have tried to hold  her and a hot compress over the leg ( biggest seroma)  , but can only manage 45 secs or so before she gets so disturbed and struggling that I feel like the struggle might defeat the purpose.

at times we have had to resort to sedating her with opioids in the overnight rat active times to get her to calm down and rest for a few hours-(  daily1 x , twice max.)
this was with the vets okay and dosing.   I asked about benadrly and or benzos but they did not want to try that when they knew that she has tolerated the opioid okay.

The SUTURES and the seromas are NOT warm  nor does anything look infected.
But it is swollen to the skins max

Can or should we take to to a Exotic ER    ( 60 mins away)
I do have metcam  and predisone from a previous surgery?
would those be helpful at this time



She was/ is in great shape for her age, and has had no myco infections in her life.

She is on SMZ TMP and doxy as preventatives for two weeks
eating, pooping   fine-  urine fine   mental-  angry!  
energy fine  actually  was too active-   maybe decreasing now as it is getting harder to move with this leg swollen.

I have also tried homeopathic remedies the entire recovery pre op regulars
-   post op  -  Traumeel  mix  , and Arnica 30C

_ Arnica 30C  alternating  Hamamelis 6c    started two days ago 4 doses daily


.Any suggestions-  this is my love and first rat of many- and we don't want to leave it and mess her up, but also don't want to keep stressing her out by not allowing her to move much and groom like normal.   

thanks   worried mom and dad

ANSWER: Hi. I'm so sorry it took me so long to reply to you, but your question was too "medical" for my expertise and I had to consult with another expert who is more medically inclined with rats.

She and I however both agree that you need to promptly take your girl to see the ER vet where the exotic vet is.  The itching is probably from the sutures...it sounds like she is reacting terribly to them.  Although seromas are not uncommon to occur, having so many at once indicates allergies to the sutures.  

Now, you may not want to hear this and I totally understand how important and special your first rat is.  She is probably the sweetest thing and you must love her to death.  But my friend and I agree that your girl is at an age where she is just to old to continue with these tumor removal surgeries.  Typically, pet rats live about 2 to 2.5 years, so your girl is at a ripe old age now.  There needs to come a point where you will need to just let her live her life out happily and not stressfully (stress due to the surgeries and sutures), tumors or not.  Based on her past tumor history, she is bound to continue to get more, due to most likely very high hormone levels.

The hardest thing in the world is saying goodbye to your beloved pet, but unfortunately you will need to brace yourself.  My first female rat also was prone to mammary tumors.  I had several removed while she was between 18 and 24 months, but when she got 2 more at 26 months, I decided I just had to leave the tumors alone.  My girl lived for about 3 more months until the tumors grew large and impeded her ability to groom, feed herself, and drag her poor body as she tried to walk, I made the toughest decision but her her peacefully put to sleep.  I made sure that I gave her as much of the things that made her happy in her last few months (ice cream and all sorts of goodies...boy this did one love to eat!).  She also was my first precious love so you have my sincere empathy.  

Good luck to you and please let me know if there is anything else I can help you with.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your reply- we did take her to someone local on Friday who just said to watch her   hmmm

and  back to the surgeon, on Monday so post op 1 week
he didn'r seem to think that
there was all that much wrong   -  he is the only one around and does tons of rats.  

He did drain the largest ( took off 5ml )  but left the other and said it would eventually go away.
She has had seromas before but never this big.   The one he drained was not infected and has returned but only 1/3 the size so she can walk.  

he thought the sutures looked okay and that she might be stressed ( Duh!)  and treated her for mites,
we treated the rest as a preventative for her.   

today is weds and she is still itchy like crazy and keeps biting the scabs off.

thinking back -  surgery 1  she had trouble  and barbered her chest and arms for about a month
Surgery 2 ( adernal)   she was great  - same meds   but he added a steroid taper to let her right adernal gland
ease into taking over which it did very nicely.

So maybe you are correct and she is allergic to the internal sutures?  not the meds/mites like has been suggested

If that is the case  do we use the left over steroids again?

 Not sure I can convince him of this-  he thought we were
pretty stupid for staying awake with her the last week.  But after her first surgery taking 3 weeks to get over
as my husband looked away once and she pulled them out a third time   we were not about to take the chance.

Our other girls have done fine after the first 2/3 days, it is just this poor girl.
Even calling him at this time and I'll get attitude.  

this will be her last surgery  we knew that going in,  she is just in such good shape-  everything I have read said to remove the tumors as long as the rat was healthy.  Which she still is- other than going out of her mind with  the itchy.
She still wants to play, roam, eat like a pig,   be petted  ect    she is a " big" personality in the house.

She is anything but ready to leave yet...I think she is way too angry and plotting revenge at this point!
Kidding,  she is the sweetest girl anyone has ever seen , extremely tame  more like a dog.
likes to hang out with us, more than the other rats.

So if she is reacting to the sutures taking steroids for a week should help correct?

Answer
Your little girl sounds awesome!  I have a rat like that right now too...huge personality, rolls over on her back and licks and licks you to death.  You've read correctly that if health is very good and a rat is strong, surgery should be fine.  And I totally understand you not being ready to let her go.  Enjoy her for as long as you can...you'll have tons of memories!

It's not my place to tell you to go ahead with the steriods without consent of your vet, but if you feel comfortable doing this and know the proper dosage, then you should make that decision.

In the many mammary tumor surgeries I've done on my rats over the years, I learned after the second one that I'll never do sutures again.  My vet used external only sutures and it was a nightmare when my rats gnawed fiercely away at them until they were completely out and left a gaping oozing hole.  We had to make several emergency trips to have the area cut and cleaned, our rats re-anesthetized, and stitched up again.  After the second time of this nightmare, I begged the vet to use staples.  He didn't have rat sized staples but I approved his using the kitten sized ones, which worked perfectly.  After that, I never had issues with my rats messing with the staples.  They didn't cause itching and they only minimally picked at them but when they realized they couldn't get them out, they stopped and healed properly after that.  Just a thought for your next surgery if you hadnt considered that.

Good luck to you and your girl!