The spirit is willing but the flesh is weak

"Can the dwarf hamster hear if I cut off his cancerous right ear pinna?" I asked myself. "Is there another method to remove the fast-growing circular skin lump on the inside of his right ear without amputating his ear?" There was insufficient skin to stitch up if the 0.5 cm tumour was cut off from the ear. Besides there would be lots of bleeding into the ear canal and the hamster might not survive the bacterial infections.

The time-pressed young lady in her early twenties said: "Uncle, I have been very busy working for this company shooting documentaries. So I have little time. In the last 4 weeks, the ear lump grows so big."

 

Skin tumours in older hamsters are common but this one has a tumour on his ear. Some 6 weeks ago, the young lady presented him with a head tilt to the right but nothing was seen in his outer ear. The hamster did look comical to the young lady and her best friend as the hamster kept walking in circles with the head tilted right. She took some pictures for me as I trusted that she would be better at photography, being a multi-media graduate. She did not disappoint me as you can see her pictures taken in August 31, 2008.

While she was dressed casual in T-shirt, her best friend dressed like a lawyer going to the court. However, she and her best friend had great laughs at the poor hamster's expense.

I admit it was funny for the average person to see the hamster turning around in circles to the right as the lady placed a dried worm for the hamster to eat. The beloved hamster was unable to get the head upright. So the little rodent had to eat sideways. Sometimes the hamster would be able to walk straight. 

It was not practical to examine the hamster's middle and inner ear due to its small size and I prescribed ear medication.

Now, the big ear tumour had manifested on the medial aspect of the ear as a crumbly angry-looking tumour. 

"What to do about this case?" I asked Jay Fire, a Myanmese veterinary technician who had some 10 years of experience in 3 small animal practices in Singapore. He was visiting me. As he was passionate about veterinary medicine and surgery, I took this opportunity to discuss with him this unusual and uncommon case of a large tumour in the ear auricle and asked him what to do about it. A different angle or point of view from an experienced Myanmese veterinarian enriches me.  

"Cut off the tumour from under the ear skin," Jay Fire proposed. It was an obvious solution and could possibly be performed in the dog. Dogs can be given painkillers after the surgery and post-operation nursing can be done easily. But this is a dwarf animal. A dwarf hamster with the ear barely bigger than a German Shepherd's toe.  

"It is easier said than done, "I said. "The tumour occupies more than 75% of the ear pinna. There will be no skin to stitch up." I said.

I explained further:  "After cutting away the tumour, there will be a very large hole. There will be lots of bleeding after surgery. How do you control or stop the bleeding as it is not easy to bandage the hamster and nurse it? The blood will go into the ear canal and become infected. The hamster will become sick and start rubbing his sore ear."

Jay Fire shook his head as this must be the first time he had encountered such a case too. Vets can learn from each other experiences by sharing points of views whenever possible. It means giving away trade secrets too.

I have no doubt that Jay Fire would make an excellent  veterinarian should he set up his veterinary hospital in Myanmar. In the meantime, it would be good to learn as much as possible from each other as veterinary medicine and surgery of various animals sometimes need solutions that are out of the box.

The removal of the ear auricle's tumour was not a problem. The challenge was the post-operation complications. The owner naturally expects improvement rather than a sickly hamster with a large infected and itchy ear should the tumour be simply removed by cutting it off.

This was one of those times the vet has to draw his experiences from other species. As I used to do ear cropping in dogs till it was banned by the Veterinary Association, I thought this problem had one solution. Ear cropping. Or more precisely, ear amputation.

SURGICAL PROCEDURE

Gas anaesthesia. A mosquito forceps clamps the lower end of the ear auricle below the tumour. The scalpel cuts away the tumour. Below the forceps, I put 2 transfixing sutures (equivalent to a horizontal mattress suture).

I have left the sutures longer than usual for vets to see in the picture. There was little bleeding when the forceps is removed.

48 hours later, the busy lady owner whom all Singapore mothers will love to have as a daughter-in-law as she is has a bubbling personality, fair complexion with big-eyes and forever a chatterbox phoned me: "When will the stitches need to be removed?"

"The stitches will dissolve by themselves in 14-28 days. You can cut the stitch shorter as I had left them long for photography.  Is the hamster irritated by the stitches? Is his ear bleeding?" I asked.

"I made an Elizabeth collar out of a card and he had to wear it," she replied. "He did not bother with the stitches and he has no bleeding in his operation area."

"Is his head still tilted to the right?" I was happy to receive good news.  

"Yes, yes...yes" the girl's bubbling reply rippled over the air. "But he is much more active now." The heavy burden in the ear had made life miserable for this hamster. I suspect that he would have less head tilt in time to come if he has no tumour in his middle or inner ear. But who knows?

It was great to know that this hamster had no reaction. Antibiotics were given post-operation and this lady would take time to care for the hamster.

"How about doing some artwork for my anti-fungal shampoo label?" I asked her as she has experience in the graphics software and was able to perform. This would be a barter trade as I did not charge for the hamster's anaesthesia and surgery as she had just found employment and the previous photographer employer did not pay her the $500 salary for a long time.  

"Uncle, I know your shampoo label is so clinical. So plain and boring like all doctor's labels. However, I work long hours doing documentaries and advertisements for this company. When I am free, I will do it."

The spirit is willing but the flesh is weak. There are so many more pleasant things to do with her spare time. This is my common observations of Singapore youths.

Besides, she is a very busy multi-media graduate earning a living by working very long hours. She earns little and has to keep up with the high cost of living Singapore. So I did not charge her for the recent hamster surgery although she wanted to pay me some money.

On my side, it is extremely difficult for me to find a graphics designer to make my anti-fungal shampoo label look well designed and good to look at. I cannot find the graphics designer and cannot afford those working in companies.

Well, it is back to the simple plain and boring anti-fungal shampoo label till this girl-next-door can spare the time for me. Or she may need to barter her graphics design expertise for veterinary surgery another time.


REFERENCES:
Types of hearing loss in human beings
(Calls to regulate sellers of hearing devices
Straits times, Oct 16, 2008, Home, Page B3)

1. Conductive Hearing Loss - Blockage of sound waves to reaching the inner ear.
2. Sensor-neural Hearing Loss - Nerve deafness.
3. Mixed Hearing Loss - Damage to outer, middle and inner ear.

In this hamster, it is hard to know whether he can hear or not as it is not practical to test him.