Front leg paralysis

Question
QUESTION: Hi Sandra
About 2 months ago, my 20 month old boy had an enormous preputial abscess (above and to the left of his genitals). It came up out of nowhere, was huge and spanned almost all the way up to his left armpit in the end. The vet drained it and he went on Baytril but it didn't do much good; we then tried Synulox, which worked very well, and the vet continued to drain the abscess (during which time she often removed lumps of greenish necrotic tissue as well as the runnier pus - it was fairly appalling and he was very poorly with the infection)

Anyway, during all this treatment (which went on about 3 weeks), he started having trouble with his front paw dexterity and developed a slight lean to the left (now imperceptible). At first, he stopped being able to hold treats properly, and would cross his paws on the floor to anchor something so he could eat it. Now, he doesn't even do that - he sticks his front legs out in front of him, and never even tried to use them, except like sticks to move food around. He can still use them to walk on fairly well, but not to manipulate anything.

He's still got an appetite, and the abscess is now cleared, but he's losing weight and it's obvious he's having trouble physically eating. He'll take a lot of food in his mouth at once and sort of tilt his head upwards so it doesn't all fall out... but obviously as rats eat by grinding food into small enough bits to swallow, it's proving hard for him. I'm making sure there is always soft food like couscous and corn available, and am topping him up with Nutri-Cal paste which he can just lick. But what else can I do?

Not that it matters at this point (the main thing is to make him comfy now, and I don't think it's reversible at this point?) but do you have any thoughts about what might have caused this? I guess some kind of stroke, and probably not related to the abscess - but isn't it unusual that both front legs and neither back legs are affected? Every time I google paralysis in rats, it's always HLD or one sided...

Be very grateful for your thoughts, as always.

Kate

ANSWER: Hi Kate

Sorry your little man is having so many problems.

I hate to be the one to bring more bad news, but your little man has a pituitary tumor. Although more common in intact females it can also develop in males.  He has all of the signs, from the loss of the use of his front paws to the inability to chew properly and also he is off balance due to the pressure on the vestibular cochlear nerve which controls equilibrium.  

There is no cure for this, sadly, and it is a progressive condition that is inevitably fatal. Steroids may help some with the inflammation on the base of his brain and also can possibly relieve some pressure on the vestibular cochlear nerve but this is short term I'm afraid.

You do not have to euthanize him unless he completely losses his ability to swallow, which is seen in the final stages of this disease.

You can read more about this disease on my web site.  Your vet may not have been able to diagnose him due to the fact this is not a disease that is commonly discussed when Vets are in vet school learning about small mammals rather than dogs and cats. They mostly  touch base with more common ailments and move on, not covering the more complicated ailments. If your vet is a certified avian/exotic specialist he would probably know about it but if not, chances are you will have to possibly copy off the info my website and share the info with your vet.

You can help your little man by giving him baby food. He can lick hopefully, but do keep an eye out to be sure he is swallowing ok so he doesnt aspirate his food.

Here is the URL about pituitary tumors along with photos for comparison.

http://www.sandyscrittercity.com/pituitarytumors.htm

Again, I am sorry to bring bad news and I really truly wish I was wrong, but I have seen this so many times I lost count.

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

QUESTION: Hi Sandra

Thanks very much for the quick response. To be honest I had already considered the fact that it might be a PT. But I had sort of dicounted it because he's not exhibiting a lot of the classic signs - like stretching out his forearms and arching his head back to swallow whilst tilting/arching his wrists up, or pushing his head up against surfaces, or walking in circles and losing his balance. Also this all started 6-8 weeks ago and the decline has not been fast. I get a sense that the difficulty swallowing is because he can't hold his food to grind it up first, rather than because he can't swallow.

It may just be wishful thinking, but is there anything else at all that could cause this? Even with the lack of classic signs, do you still think it's certainly a PT? My vet has a lot of experience with rats, and we've got an appointment witb her on Friday (she hasn't seen him since this has got worse and was obviously concentrating on getting rid of the abscess up til last week!) so I'll definitely raise it with her.

Assuming it is a PT, a shot of Dex and follow up with steroid tablets? I know this would only be short term, but judging by the slow decline, maybe we have a little while yet...?

I lost one of my older gents yesterday (2.5yrs) so it's all a bit sad at home this week!

Thanks for your help
Kate  

Answer
HI Kate

I would love to be wrong. In fact, I hope I am wrong, but through the years I have seen so many things that were far from classic textbook" I have learned not to count on major signs and symptoms. Sometimes you only need one sign, and other times, none. An example would be porphyrin discharge.  Typically, porphyrin discharge is seen when the harderian gland produces an over abundance of porphyrin when the rat is stressed due to illness or anxiety, typically. However, I have had rats of my own and have also see rats come into  the clinic oozing porphyrin and not the least bit sick.  I had a rat that lived to be over 4 years old that had a red stained nose every day of his life and never had any health problems at all.  
About four years ago I had a male rat that all of a sudden began to bite on the cage bars and demand to be taken out.  He wanted held all the time. When he did get down, he would walk around the floor aimlessly as if he was looking to go somewhere although he did not know where he was going.  It was sad for him, puzzling to us.  It got so bad he would freak out and panic when he heard me and demand to be held.  If he did not hear me he was fine so I put a blanket over his cage and did not talk when I went to the rat room until I got him to the Vet. Just as baffled as I was, Casper acted the same way there with the staff as he did at home. He would panic, chew and pull at the cage door and freak out until someone held him.  His heard and lungs were fine.
I started to remember back when I had a little female who acted the same way as he was acting but she started to also lose control of her front paws. She ended up having to be put down and it was from a pituitary tumor. Casper lacked all signs of a PT but he did have the behavior problem. My vet, who is a very well qualified avian/exotic vet, shook his head at me and said that chances are, knowing me, I am right, but it just did not fit the pattern of a pt. He never even heard of a rat wanting to be held all the time with a PT.  I did further research and found that they can indeed suffer from behavior problems, including anxiety.  We put him on valium which helped a short time, but it got so bad he began to have panic attacks all the time. We had to let him go.  Necropsy showed a tumor the size of a grape on his pituitary gland that was so large it left an indention in his brain tissue.  Poor boy tried to tell us and I am glad I knew what was wrong and did not make him suffer any longer.  No other signs of a PT other than the anxiety.  So that said, I dont always go by classic text book signs any more.  

Again though, I hope I am wrong. I would do back flips to be wrong when it comes to something terminal like this. Time will tell, I am afraid,but with the steroids, providing you can twist your vets arm to prescribe it when so many vets are scared of it, hopefully the vet will realize there are more benefits to this that outweigh the risks.  
I wish I could say that it could be something else, and it may very well be, but it still sounds neurological.

I am sorry you lost your older boy yesterday.  I was losing my older boys every few weeks starting from December thru June and found myself for the first time in I dont even know how many years, totally without rats.  I was empty without them and it did not take long before my breeder called with three new pups for me. So I started all over again in June with 4 week old maniac babies that fly rather than walk.

Please keep me updated on everything. I will put your name in another file along with the case so I can keep up with what is going on and again, I will pray that I am wrong about this but I do hope it is resolved soon so he can begin to feel better!