Shaking head, porphyrin staining

Question
QUESTION: Hello Sandra,

We recently wrote to you about our 1 1/2 year old boy, Bear, who
developed soft tissue sarcoma on his chest under several layers of
muscle.  Just as an update, he's recovered very well from the
surgery, and as far as we can tell, the tumor has not come back,
though our vets caution us that it undoubtedly will at some point.
He's going to see a veterinary oncologist very soon, so we'll see
how that goes.

This message concerns Bear's older brother, Stuart, a Himalayan male who is just over 1 1/2.

Back in late June, he began to develop porphyrin staining around
his left eye.  We took him into a vet (our regular vet was out of
town) who prescribed him antibiotic eyedrops for a week.  The
staining went away for about a week after the treatment stopped,
and then came back.  We took him into our regular vet, who once
again prescribed antibiotic eyedrops.  These seemed to be working
as well, but 36 hours after the treatment ended, we woke up to
find Stuart's cheek very swollen under his left eye.  This was in
mid-July.  He also had a bit of a limp on his left foot, so we
figured maybe he had injured himself while playing with one of his
brothers.  He had also been losing quite a bit of weight over the
course of the week prior (from 464 grams down to 412).  We took
him to the vet that same day, and he decided that it was probably
an abcess in his molar or cheek, which might have been causing the
porphyrin and impeding his food intake.  Stuart was given oral
antibiotics twice a day and the swelling went away after a few
days (his foot was healed by the next morning).

The porphyrin staining still occured periodically, but not very
often and not in high volumes, so we decided to just observe for a
while and see what happened.

In early August we moved from the Puget Sound area of Washington,
to Moscow, Idaho.  Within about a week of arriving, Stuart started
having more staining around his left eye (never around his right
eye, and we never see any staining around his nose).  It pretty
quickly became more than he'd been having before.  We took him to
our new vet here, gave her his history, and she listened to his
lungs and heard nothing abnormal, but she started him on a course
of Baytril for several days before putting him under anesthesia to
get a good look at his teeth and jaw to see if maybe the suspected
abcess were still giving him trouble.

She saw no indication of any remaining troubles with his molars or
cheek.  While he was under, she took a radiograph of his lungs and
they looked very healthy.  The only suspect was that his lower
incisors had grown a bit too long (perhaps as a result of the
swelling/abcess/whatever in his cheek/mouth making it hard to keep
his teeth in check?), and she gave his teeth a trimming while he
was under. He was kept on the Baytril for a while following this
just in case there was something else going on.

When we first moved to Moscow, my wife noted that she'd wake up
with a sore throat from the arid weather (often 20% or lower
humidity).  I bought a humidifier for the bedroom, where our rats
were, and noticed that when the humidifier had been running full
blast, Stuart's porphyrin staining seemed to be reduced.  I
mentioned this to the vet on our next visit and she thought
perhaps it was something to do with maybe a duct or something
getting gunked, made even worse in the dry Idaho weather.  This
could explain why the eye drops our other vets gave us seemed to
work, not so much for the antibiotics but because the moisture of
the drops themselves.

So we've been keeping the humidifier up trying to keep the room
from getting dry (best we can do is 40-45% humidity at 72
degrees), and we're giving him human-grade artificial tears.  This
seemed to greatly reduce the porphyrin for a few weeks, but over
the past week or two, it's been seeming to increase again.

Yesterday I began noticing that he was shaking his head fairly
often...maybe as much as once or twice a minute... this isn't the
swaying side-to-side ala motion paralax, but a brief, rapid
rotation back and forth along his longitudinal axis.  There's also
a bit of ear-digging once in a while.  I've listened to his
breathing, and haven't heard anything abnormal.  He does sneeze,
but he's been a sneezer since the day we got him, and it doesn't
seem to have increased.  His appetite and water-intake are good,
and his energy level seems very good (he's not backing down from
tussles with his much-younger brothers), I haven't noticed any
head tilting or balance issues, and his coat looks very good...but
the head shaking has me worried.

On top of this, Stuart was developing some small sores at the base
of his tail while on the Baytril a few weeks back.  Our vet did a
scraping and didn't find any evidence of mites, so she gave us
topical wipes just in case it was an allergy or something, and
after several days of treatment with the wipes, the sores went
away and haven't returned.

Sorry for the extremely long message, I just wanted to get as much
info on his history as possible.

We're going to take him into the vet this week to get him checked
out again, but this has been a very long ongoing mystery (poor guy
has been to the vet 6 or 7 times since May).  Are there any
possibilities or ideas that jump out at you that we're missing?  
Is there anything we can do at home to narrow down the causes in
the mean time?

My best guess based on what I've read is either an ear infection
or possibly ear mites?  The tail sores make me suspect the latter
(our vet said mites were still a possibility despite not finding
anything in the scraping).

Thanks again for all your help!

ANSWER: Hi there!!  

I am really thrilled to hear that the surgery was a success.  

I wanted to ask you though, if the diagnosis from the vet was soft tissue sarcoma or were you going by what I diagnosed it at (I call it virtual diagnosis)  Just curious if the Vet agreed with what I said.

I am glad its not growing back, and usually they are pretty invasive, but sometimes they are encapsulated which would be awesome.  

As for the other rat....is the abscess gone? Thats my main concern.

Have you noticed any bloody discharge from the ears? Any odor?

Let me know about the location if its still there and if you can take a photo, that would help.

I am going to rule out (or at least hope I can rule it out) zymbals gland tumor.  I will go into more detail once I see a photo if you can get one but if not, I will still let you know my thoughts on our follow up.

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

QUESTION: Bear's Soft Tissue Sarcoma was diagnosed by the pathology done on
the tissue that was removed during his surgery, so you were 100%
correct on that one. I'll let you know what his oncology team
decides is the best course of action once they look him over
tomorrow.

Stuart's abscess is gone, we're pretty sure.  When he had it, it
was centered directly beneath his left eye, causing it to pinch his
eye about half shut most of the time. Our new vet put him under and
looked over the entire inside of his mouth looking for anything
abnormal and didn't find any signs of an abscess or other growths.  
So it's been gone for about two months.

Truth be told, our previous vet never confirmed it was an abscess
for sure, he just gave him antibiotics when he saw the swollen
cheek, and since it was gone within 4-5 days, he assumed that must
have been it, although the fact that it was accompanied by bruised
leg and limp leads us to believe he could have bumped his head in a
fall, which caused the swelling.  One of our other rats, Toby, was
bullying and chasing the other rats aggressively (especially
Stuart) at the time, which we thought might have been the cause of
Stuart's injury.  (Toby was neutered shortly afterward and has been
a been the biggest ball of sweet, mellow fluff since)

Knowing for sure whether it was actually an abscess or just
swelling would have been nice so we could know if it was
diagnostically important...our vet at the time wasn't really a
"hands on" type with our boys.  We never did see it come to a head
or drain on the outside, though it could have just done that in his
mouth, so we never thought much of it.  Also, the decrease in size
was gradual over several days, and never seemed to shrink rapidly
as if it popped.  When the lump originally developed, we had
handled him 6 or 7 hours before it appeared at full size, and there
had been no noticeable protrusion...so it basically appeared from
nowhere in 6 or 7 hours and then stopped growing by the time we
handled him...  I know abscesses can grow rapidly, but that seems a
bit outside of the parameters.

There has been no bloody discharge from his ears that we've seen,
and other than his regular boy rat stink, no odors we can perceive.

We took Stuart into the vet this afternoon (we were lucky to find
an open time slot).  She checked him over for mites on his skin,
and used a scope to look in his ear.  She saw no sign of mites in
his ear, but got a quick glimpse of his tympanic membrane and
noticed some redness.  Because he just got off Baytril a couple
weeks ago, she didn't want to start loading him up with
antiobiotics right away, so she gave us a topical ear drop
(Gentamicin Sulfate with Betamethasone Valerate) to give him a
couple times a day for a few days to see if that has any effect on
the head-shaking.  If not, we're going to put him on a antibiotic
other than Baytril and hope that clears it up some.

Any suggestions for the best course of action or ideas on a
diagnosis?

Thanks again!

Answer
Hello again!

I am going to agree with the swelling possibly being from trauma if you did not see anything excreting from the mass. If it was draining in his mouth, it would taste horrid and you would notice him dragging his face or rubbing his face on the floor. Rats do this when they have either (A) a bad taste in their mouth or (B) feel nauseated and since they cant vomit physically, they try to get rid of it by those actions or else laying real flat on their tummy applying as much pressure to their diaphragm as they can. The pus drainage would be bitter (or so one would imagine at least) and the odor from his mouth would be pretty offensive too. You would definitely notice. Bacteria from an abscess mixed with normal bacteria flora in the mouth would smell, well there is no other word for it than saying "gross"!  lol

I also agree if the vet saw some redness in the tympanic membrane the ear drops used first is a good move. If he doesnt respond to them, I usually like zithromax or amoxil for otitis media if baytril isnt used.

Please keep me posted. Seems that things are looking up for the boys!
Speaking of which, I loved the comment about the boys not having any usual odor other than normal "boy stink"!  That reminded me of a question I had not long ago.  A reader wrote in and was concerned because her rats had lost their natural "popcorn" odor and wondered if the rat was ill or not.  I must say, I never labeled my rats as smelling like popcorn let alone anything else that was appealing to the soft palate....ok maybe grape soda and toss in a little urine marinara on the side.   lol !