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Pituitary Tumour or Trauma? Looking For Advice

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Theletterv

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Hi there, just in the past few days I noticed one of my girls not acting like herself. At first I thought she just seemed a bit tired and weak, wasn't coming out as much, kind of keeping to herself and sleeping more. But she didn't seem to have any other obvious symptoms, and didn't seem to have any respiratory symptoms which was what I was mostly concerned about. However, within the past couple days I suddenly noticed she could not hold food anymore to eat. She was having a very hard time eating dry foods. Over the past two days this has gotten a lot worse; she was still climbing a bit the other day, but cannot climb now. She can't really eat anything unless it is soft and liquidy or I hold it for her. Just overnight she got a lot worse, now seeming very weak, and now her back legs are affected as well, and her legs are all held rather stiffly. Her front paws also sometimes bend over, like they're "knuckling over". She can't groom herself very well and walks very slowly. Just the other day I suddenly realized her symptoms looked like a pituitary gland tumour, so I got the first vet appointment I could (most of the vets near me were booked for weeks) and I brought her in today. I don't have experience with this vet, but the clinic does see rats and other small animals.

Now, the vet told me some stuff that I didn't think was true about rats and pituitary tumours. For example, that they are rare in rats, and that they grow very slowly, and I wouldn't see the symptoms come up so suddenly. He thought maybe she had fallen and injured herself. I try to keep the cage filled up with lots of places for them to land if they fall, but it is still possible, as it's a big cage, and an unlucky fall could have happened. On top of this, he said that her neck was very painful when he palpated it, so that made him think it was more likely a fall. Poor girl is feeling very bad right now, mostly curled up and sleeping. Earlier today I thought I might have to have her euthanized today because she just seemed so uncomfortable. I was, however, looking into getting cabergoline prescribed for a pituitary tumour, if the vet thought it was worth it (considering how bad she seems to feel), but instead she's on a painkiller and anti-inflammatory, and I'm supposed to see how she does through the weekend. Steroids were mentioned but not given because they have more side effects, I guess, and the vet thought to try this first.

I just wondered if anyone who has experience with falls/pituitary tumours might be able to offer some advice. Can trauma cause these kinds of symptoms? She doesn't seem to circle (but she doesn't really walk around enough to notice) or do any head-butting, and she doesn't have a head tilt, but her arms and legs are stiff and she is very clumsy. She not only cannot hold food but also seems to have trouble chewing it, and eats very slowly. (So I have been giving her soft food and soaked pellets, which she does eat.) She has excess porphyrin in her nose and eyes, but I guess that would be natural given that she is in pain and not feeling well. I just want to do the right thing by her, and of course will have her put to sleep if I feel she is suffering too much and there isn't enough hope of a good recovery / alleviation of symptoms. I'm just a little confused about what is really going on with her.

Oh, also, editing to add that she is just under 1 year of age, she was born last year in early August. I thought pituitary tumours were more common in older rats, but I also thought she may just be one of the unlucky ones.
 
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lilspaz68

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Under a year is very worrying to have symptoms like this. Can you get a video of her, even if she doesn't move sometimes their position when lying down at this advanced stage can help. I assume she was given oral Metacam (meloxicam)? How much does your lass weigh? What concentration is your Metacam (1.5 mg/ml or 0.5 mg/ml) and what dose is she getting? PT sadly used to be uncommon but isn't anymore due to the prevalence of bad breeders out there not breeding for health anymore.
 

Theletterv

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It's Meloxicam, which is the same thing as Metacam apparently, that is a brand name whereas Meloxicam is the name of the drug. It's 1.5mg/mL and she was prescribed 0.05mL every 24 hours, I think she is only about 250 grams but she has lost a fair amount of weight. She is fairly small. She, along with her sisters, is a rescue so she may very well have bad genetics unfortunately... It's terrible to hear that they used to be uncommon and are now more common due to bad breeding. :(

I got some video clips of her. Excuse her sticky fur... She kept falling into her soft food. I was offering her some Ensure (sometimes with baby rice cereal, or sometimes with soaked oxbow pellets to try to entice her to eat it). She often sticks her front legs out like this and falls over backwards. It's quite alarming because she went from completely normal, to not being able to hold food but otherwise seeming generally okay, to this in maybe three or four days.




The last one just shows how weak her jaw seems to be, she can only very slowly chip away at cheerios or yogurt drops (some of her favourite things, so I offer them to her).

It just looks very bleak and makes me sad. She's so young so part of me wants to try treatment, but part of me also thinks she is suffering. And I am also thrown off by my vet thinking it may be an injury rather than a tumour.
 

lilspaz68

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She looks like she has classic PT,but the earliest I personally have ever seen it was 14 months. I would definitely try to treat. Ideally a dexamethasone injection to start, and oral prednisone to take home. And a prescription for bromocriptine you can get filled at the drug store could give you the best results. Poor beautiful girl :(
 

Theletterv

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Thank you for your response... Yes, I thought that's what it looked like. :( It is so sad because she's so young. She's still holding out and I do think the meloxicam has given her some relief, although she is mostly the same. I do wonder if she hurt herself falling several days ago, but I think she only fell because of a PT. Her neurological symptoms are still the same. But, she seems a little brighter and like she's in less pain, but I guess a painkiller could do that regardless of whether she had an injury on top of it. It's still pretty hard for her to eat and she also very rarely seems to drink any water, I've noticed. Which apparently is another possible sign of a PT.

I took her to a second vet this morning and unfortunately, as I feared, the vet was not very helpful. She thinks it's a middle or inner ear infection, despite her not having a head tilt, and not being able to eat with her hands. She wouldn't give a steroid because "steroids are not given to rats, it is unsafe, and there is no information about proper dosing". So, she does not have a steroid, sadly. I have enrofloxacin to give her, however, for what little good it will probably do. I managed to talk the vet into prescribing either cabergoline or bromocriptine -- now that I think about it, she didn't tell me which, but I suspect it's cabergoline. It is, however, going to cost me about $220 to get it from a compounding pharmacy because she said the 0.5mg pills could not be safely dosed. I had to sign a medical release form to treat for my personal diagnosis.

I am just really fed up with vets. :(
 
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Theletterv

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I am relieved because I was able to get a prescription for prednisone from a different vet, even if I will have to wait at least a couple days to get it. I have her eating a mixture of soy infant formula, baby rice cereal, and ground up oxbow pellets with added pedialyte because she really is not drinking at all. I've also been giving her some fruit to try to up her fluid intake, although that has not been very successful. I sure hope the cabergoline will make a difference for her. I should be getting that also in a couple days, because it has to be compounded at a special pharmacy. Fingers crossed.
 

Theletterv

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Yeah, I confirmed with the lab that it is cabergoline, I forgot to update on that. I knew it was expensive but I guess getting it compounded, and not just buying the 0.5mg pills, it is even more. But, I do think it's worth it if she responds well to it. Although that isn't guaranteed.

I'm in lower mainland BC near Vancouver. I've asked about good rat vets in the area but it's been difficult to get any answers, and searches have all yielded posts that are years old, so I don't know how reliable they are, but both places I went had some reviews from rat owners and advertised that they saw rats. I tried other places as well (including those that I'm familiar with myself) but they were booked up for weeks unfortunately. I'm going to do more searching/asking around now that I am not in as much of an emergency.

Oh, also ... the vet did not actually say, but I assume I shouldn't be giving metacam and prednisone together? It's strange that the vet didn't specify, so I should probably call and ask, but I wonder if they shouldn't be combined.

Edit: I have looked into it and most sources say to wait 24 hours if going from metacam to a steroid or vice versa, so it seems important not to combine them.
 
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lilspaz68

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your research was good, NSAID's (metacam, ibuprofen etc) cannot be given at the same time as steroids and you need a 24-48 hour washout period between normally. In emergency situations though you can just switch.
 

Theletterv

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Are you near Coquitlam? SARS Rescue uses this vet, so the vets there have tons of rat experience and are very good. WESTWOOD HEIGHTS PET HOSPITAL
Thanks very much for the suggestion! I think this is where I will be going in the future, plus it's pretty close to me. It was one of the places I called, but they were booked up for too long at the time and I felt I needed to get her in to see someone right away. I wish that hadn't been the case, because I probably would have gotten better advice and care for her there.

Also, the cabergoline came in today. Despite being grape-flavoured she's not too happy about it because it's a larger amount than the other meds, but it only has to be given every three days, so that's nice. Unfortunately, no steroid today, so it will probably only be in on Monday. Right now she is on metacam and baytril along with the cabergoline, and when the steroid is ready she will be on that, the baytril, and cabergoline. I know antibiotics are often given in conjunction with steroids because of the risk of respiratory infections particularly in rats. I was wondering, first of all, whether rats with PTs are on steroids for the rest of their lives (I am guessing so), and I also wondered whether she should be kept on the baytril indefinitely or not. I sure hope the cabergoline has a positive effect.
 

lilspaz68

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I would stop the Metacam now as you need to have a washout period before starting steroids. With my rats I would keep them on steroids and the dopamine agonist initially then start weaning off the steroid slowly watching for any signs of serious regression indicating that they might need to stay on the steroid. Most of mine have come off the steroid and just been on bromocriptine/cabergoline.
 

JamesBC

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There is one great Vet in Abbotsford BC, Dr Green takes care of our rats and he is very knowable about them. He does only exotic pets which Rats are. He is at the Coastal Rivers Pet Hospital. You must have an appointment as right now no pet owners are allowed in the building, you call when you get there and the staff comers out to take the pet inside.
 

Theletterv

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I would stop the Metacam now as you need to have a washout period before starting steroids. With my rats I would keep them on steroids and the dopamine agonist initially then start weaning off the steroid slowly watching for any signs of serious regression indicating that they might need to stay on the steroid. Most of mine have come off the steroid and just been on bromocriptine/cabergoline.
Okay, that makes sense about the steroid. It seems that steroids are usually recommended for short-term use so I wondered. It would be best if she could eventually be weaned off of it, but we'll see. So, it's best for her to be off the metacam for 48 hours starting today, until the steroid presumably is ready on Monday?

There is one great Vet in Abbotsford BC, Dr Green takes care of our rats and he is very knowable about them. He does only exotic pets which Rats are. He is at the Coastal Rivers Pet Hospital. You must have an appointment as right now no pet owners are allowed in the building, you call when you get there and the staff comers out to take the pet inside.
Thanks for the suggestion! They're a bit far from me, but if I get into a situation where no one else is available, it would be good to have them as an option seeing as I know they have rat experience.
 

SQ

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I keep my pt rats on pred + baytril for the rest of their lives, but some discontinue using the steroid if the cabergoline is helping (Cabergoline only helps with the most common type of pt)

as for cabergoline in case it is difficult to get or more expensive, my vet writes a prescription and I get it filled at the human pharmacy ... it is in pill form and they hate the taste (I dissolve part of the pill in water to orally syringe feed). A rat takes approx 1/2 a pill each time


Hope the meds are helping
 
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Theletterv

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I finally got the prednisone, a day later than I expected, but at least I have it now. I was more so hoping for dexamethasone because it is stronger and apparently rats with PT may need a higher dose of steroids. But I take what I can get... I am just happy I was able to get her this.

I'm not sure, however, if she's on a high enough dose or not. I should note that my old gram scale was giving me problems, and that both the vet and a new kitchen scale have told me she is 320g, which is better than I thought, though she is skinnier than before her symptoms started. Her prednisone is 1mg/mL and she is on 0.3mL every 12 hours. Just in case anyone has any suggestions about her dose.

Overall, she's doing okay. I wouldn't say her mobility is any better, but she is eating her "porridge" and seems to be in decent spirits. Sometimes I think she is able to stay upright while grooming a little bit more. And she seems less agitated, though still mostly sleepy. Though she hates me giving her all these medications! Even if they are banana and grape flavoured.
 

Theletterv

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I just wanted to post a video of her eating a corn flake yesterday. She isn't 100% by any means, but in the last few days she has started being able to hold things again, with it getting progressively better. It also seems like she is able to chew things better as well. Her ability to groom herself has improved as well, and she no longer has porphyrin staining her wrists, which was something I noticed as her symptoms started getting worse. I feel like I started noticing her using her hands more maybe by her second dose of cabergoline, although I am sure the vets I've seen will say the antibiotic has helped an inner ear infection or that anti-inflammatories/steroids have helped an injury. Granted, because I didn't agree to wait a week before trying cabergoline to see if the antibiotic alone would help, I can't prove that it is what has helped. But there is quite a noticeable difference in her all the same.

 

Theletterv

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I was wondering, how long into treatment should I consider trying to wean off of the prednisone in case cabergoline alone is enough for her? And how slow is the weaning process? I know it has to be done carefully because withdrawal from steroids can be very dangerous. I would, of course, stop weaning her off of it if I saw any regression, but at some point it might be worth trying to see if she is fine without it, because there are risks involved with long-term steroid use. (And I worry about my ability to get antibiotic refills with my vet, to be honest, and she needs to be on antibiotics while she is on steroids...)
 

Theletterv

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I just wanted to update that my little girl was put to sleep on Sunday. Her symptoms came back suddenly about a week ago and rapidly got worse, despite all her medications, and she was clearly suffering. A necropsy was done and proved that she did have a fairly large pituitary tumour, so at least there was closure. I just wish she could have had more time.
 

skylamps

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Poor girl. You gave her the best life possible and it's obvious you cared so much. If nothing else - she had a wonderful last few days with you. I'm so so sorry this happened :(
 

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