VCBE Case of the Month

Little hedgehog, Big surgery
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Poe, a 3-year-old female hedgehog, was initially brought into the Veterinary Center for a growth on her chest.  The doctors examined Poe and noted that the growth was large and stretched the entire length of the left side of Poe’s chest.  Using a small needle, the doctors took a sample of the growth (called a fine needle aspirate), which was submitted for analysis by a pathologist.  The results came back within a few days,  suggesting that the growth most likely was a carcinoma, a malignant cancer.
The best course of action was to remove the growth surgically, so Poe returned to the Veterinary Center a few days later for pre-surgical x-rays.  Hedgehogs are notoriously difficult to examine, as they curl into tight balls with only their pointy spines exposed.  While hedgehogs can not “shoot” their spines like porcupines can, they do have very strong back muscles and once curled, they are impossible to examine.  For this reason, Poe was briefly sedated with gas anesthesia using a mask over her face.  X-rays were taken to make sure that the growth did not involve her ribs and that there were no obvious growths internally.  Thankfully, the growth was located completely outside the rib cage and did not involve the ribs.  In addition, there did not appear to be any internal abnormalities.
Poe returned at a later date for surgery.  She was given an injection of a sedative and a pain medication and was anesthetized using gas anesthesia delivered by a mask (see picture).  An intravenous catheter was placed in a vein in her front leg, and she was given intravenous fluids to help maintain her blood pressure during surgery.  She was also given an injection of an antibiotic.  The Veterinary Center technicians monitored Poe very closely while she was anesthetized.  Her heart rate and rhythym were closely monitored with an electrocardiogram, and her breathing and temperature were closely followed, as well.  Dr. Hess and Dr. Ravich worked together to remove the growth, which, although quite large, was able to be removed completely.  The incision site was sutured closed, and Poe recovered from surgery in a warm incubator.  Once Poe was awake, the Veterinary Center technicians syringe fed her a special diet made for omnivorous (meat and vegetable-eating) animals, which Poe ate well.  Poe was sent home the following day on a pain medication.
For the week following surgery, Poe’s owner diligently cared for her, ensuring she received her medication and was eating well.  Poe returned to the Veterinary Center one week later for her post-surgery recheck exam.   The Veterinary Center staff knew Poe was feeling well when she curled up so tightly her surgery site was not visible.  The doctors sedated Poe again and removed her stitches, as the incision had healed well.  Poe was sent home and seemed to be back to normal.
Poe was brought back in to the Veterinary Center a few months later for weight loss and green diarrhea.  She had lost about 1/3 of her body weight and was quite thin.  Poe was sedated and an oral exam, bloodwork and x-rays were performed.  Hedgehogs commonly get dental disease; however, Poe’s oral exam was normal.  One value on her bloodwork, called BUN (blood urea nitrogen), was elevated which can indicate dehydration, early kidney disease, or intestinal bleeding (from ulcers, for example).  Poe’s x-rays showed that her intestines were dilated with gas, a condition called ileus in which the intestines have slowed down and are not moving food and gas through normally.  The doctors were suspicious of an intestinal problem such as an infection, so a sample of Poe’s stool was examined under the microscope using a special stain.  The doctors discovered that Poe had large numbers of an abnormal bacteria called Clostridium, as well as a yeast infection, in her intestines.  It was possible that due to the anesthesia and antibiotics Poe was given for her surgery, the type of bacteria normally living in her intestines changed gradually over time to mainly abnormal gas-producing bacteria.  Poe was treated with fluids given under her skin for hydration and was sent home on an antibiotic called metronidazole  that works well against Clostridium, as well as a medication called sucralfate which helps to heal intestinal ulcers. 
Poe returned for a recheck exam 1 week later.  She had gained back half the weight she had lost.  An analysis of her stool showed much improvement, with only moderate numbers of Clostridium noted and minimal yeast.  The doctors recommended that she continue on the antibiotic one more week, so Poe was sent home.  After the second week of the antibiotic, Poe’s stool was checked yet again, and it was completely normal.  Since then, Poe has been back to her normal, playful self!
 

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