Home and On the Road to Recovery

Virga and Cirrus underwent surgery at the University of Illinois Veterinary Teaching Hospital on Thursday. We brought them in around 10:00 a.m. and met with our vet. She went over what exactly was going to happen with each glider. One change from what she had thought earlier was that they would not be spayed. Since  Dr. W. felt that these tumors were possibly hormonally driven spaying them would eliminate the hormones from the equation.  However, spaying is a fairly serious procedure for sugar gliders, and she felt the risk from that surgery was too high, and we agreed. Instead, they removed the mammary glands along with the tumors, and then performed a "pouch ablation" to minimize the potential for residual mammary tissue being left behind and for abnormal cell growth to reoccur. The pouch is more or less a flap of skin, so this was a much less traumatic procedure than spaying.  It left both of them with about a one inch incision that was closed with internal sutures and externally with tissue glue.

Surgery was scheduled for early afternoon.  Virga was first, and her surgery took about an hour. The two tumors had grown together and were hard to distinguish as separate masses. When her surgery was completed, Cirrus had her surgery, which lasted about 40 minutes.  Dr. W called about 4:00 p.m. to let us know both girls had made it through surgery just fine and were awake. However, they were going to keep them overnight in ICU so they could be given injectable pain meds and watched carefully during their waking hours.

Virga and Cirrus at home in their e-collars.

We had sent along e-collars and two new e-jackets with Virga and Cirrus. The e-jackets are a relatively new device that has been successfully used with gliders to keep them from self-mutilating. On Wednesday night I practiced getting Virga into her e-jacket, but it took three tries before I got it right. After surgery they tried to get Virga in her e-jacket, but she wiggled right out of it. Rather than stress her out they went with the e-collars. One of the e-collars we have attaches with snaps and works quite well most of the time.  They tried it on Cirrus and she had it off in two seconds. The second e-collar wouldn't stay on, so the vet and vet techs made two e-collars out of old x-ray film. Not fashionable, but very effective.  The ladies had a pretty good night and cuddled up in their hospital cage. They ate a little, and apparently were loved on by the ICU staff.

I picked them up at the hospital on Friday about 11:00 a.m. The two vet med students that had been working with Dr. W and with us the last few visits explained the care needed for Virga and Cirrus. The incision site on both was a little swollen, but that was to be expected.  Otherwise both gliders looked groggy, but good.. Dr. W went into a little more detail on the surgery. To her knowledge this particular procedure has not been done before on gliders for treatment of mammary carcinoma. She was not able to find much in the veterinary literature about mammary carcinoma in gliders and the vets she spoke had heard of it but did not have much direct experience with it. So, Virga and Cirrus may end up being pioneers in glider veterinary care.

For all they have gone through, Virga and Cirrus are doing remarkably well. They ate last night, starting off with an appetizer of a few mealworms. They were mildly active in their cage last night. One of the medications they are on includes a mild sedative, and we really don't want them to be too active. We have them a a small cage in our bedroom so we can hear them in case something is wrong. The are able to climb a bit, but that's about it. They seem to be even a little more active tonight, and their incision sites look very good. They are eating and drinking.  The definitely do not like their e-collars, but seem to be a little more tolerant of them today. On Monday we will  put them in the e-jackets, which will give them more freedom of movement and make it a little easier for them to eat.

Their follow-up appointment with Dr. W is in about seven days. By that time we should have the results of the histopathology of the tissue that was removed. They should also be just about ready to rejoin CB and Foehn and normal glider activities.

From Bad to Worse

Virga is scheduled for surgery on Thursday to remove the two masses on either side of her pouch, so we are in the process of making preparations for her care after surgery. In the meantime, yesterday morning M observed Cirrus aggressively grooming her pouch  during the gliders' morning yogurt time. When she checked Cirrus' pouch she found it raw and irritated around the outside of the pouch from overgrooming. Back to the vet we went today. Dr. W immediately noticed that her pouch was worse than two weeks ago and wanted a better look. So, off went Cirrus to go under general anesthesia so they could get a closer examination. When Dr. W came back into the room with a camera we knew the news couldn't be good. The photo showed Cirrus had a growth about the size of a pea on one of her mammary glands. Dr. W wanted to do a needle aspiration for a cytology and of course we said go ahead. The results were supposed to be available late today.  The phone rang around 7:00 p.m.and M took the call. The news was not good. While Cirrus' mass is much smaller than Virga's two, it is definitely cancer (while Virga's may be pre-cancerous). Dr. W called another well-known glider vet to consult with him, and he said he had never encountered a glider with breast cancer, let alone two. Our vet will be calling other vets she knows with glider experience to see what light they might shed on all of this, but it looks like we could be forging new territory.

It's very possible Cirrus may be joining Virga in the surgical suite on Thursday if they can swing it.  It will be a little crazy for us for a few days caring for two recovering gliders but it will probably be better for them not only from a medical standpoint but also for their social well-being.

Our two ladies just turned 9 years old this month (we've had them two years) and they are pretty special to us. Not much of a birthday for them, but hopefully Thursday's outcome will mean more birthdays to come.

Headed for Surgery

Our vet called this morning with the results of the diagnostic procedures Virga went through. The news was not good.  The cytology indicated abnormal cells. Dr. W said if we decide to have surgery, she recommended it be done as soon as possible. When M called me with the news, we didn't have a lot of time to talk since I was in the middle of something at work. Dr. W said to take the weekend to think about it, but we both knew our decision without either of us actually saying it. We will be calling first thing on Monday to schedule Virga for surgery at the University of Illinois Veterinary Teaching Hospital. Dr. W said that the surgeon was ready and waiting, and has had experience with surgery on gliders. He apparently also has a soft spot for gliders and enjoys dealing with them (in contrast, I guess, to some who don't like dealing with small exotic pets).  Dr. W has been doing some background research and is going to be contacting another vet who has experience with this type of carcinoma for more information.

There was some good news in all of this. The x-ray confirmed that the suspected cancer has not spread. Virga's blood workup showed her liver was in great shape (this would be the next organ likely to be affected if the cancer spreads), and that overall she was in great systemic health. She feels that Virga should come through this fine and live out a normal healthy life.

And right now, Virga is getting her evening run in on the wheel.  No wonder she is great general health with all the exercise she gets!

Another Long Vet Visit

Today was Virga's follow-up appointment with our vet after two weeks on meds to treat possible mastitis. The good news was that the pouch opening was smaller and appeared to be better, but on closer examination the lining was still red and inflamed. And, the two masses were still there.

Rather than going to a biopsy, our vet Dr. W decided it would be best to do a fine needle aspiration of the masses for a cytology. This, of course requires Virga to have general anesthesia, so this visit was shaping up to be like the last one. I brought Virga in by myself today. M had to stay home with our grandson who had a tonsillectomy and adenoidectomy on Monday and is staying with us for the week.

After the examination Virga was placed in a plastic container while I signed the consent form.  Bright lights and strange smells were taking the place of her normal sleep time and she had none of the things she was secure with. As Dr. W finished briefing me on what was going to happen, Virga was watching me and the look on her face seemed to be saying "What is going on and why are you leaving me here?" She was obviously scared and not sure of what was going on. 

Prior to Virga going in for the procedure, Dr. W consulted with a vet surgeon about Virga's case and checked related pathology reports. The surgeon said that if and when there was a biopsy it would be prudent just to remove the masses rather than subject Virga to two surgeries. Prior to putting Virga under Dr. W called me and said she would like to do a full body x-ray and draw some blood since Virga would already be under. This would save another step if further treatment is needed.

The procedure was supposed to take an hour, but at two hours I still hadn't heard anything and was getting worried. I checked at the desk and they told me they had just finished. Turns out Dr. W had a "hamster emergency" and they got a late start on Virga.

Dr. W brought Virga out and sat down with me to explain what she knew at this point. We will have to wait for the x-ray to be read by the radiologist and for the cytology and blood work to be completed before we know anything for sure. She said she did take a look at the x-ray and she didn't see signs of anything spreading, so that was good to hear. On the other hand, the mass on the left side that was not visible through the pouch two weeks ago is visible now.

Dr. W said that mammary adenocarcinoma has been reported as the most common mammary cancer in sugar gliders, representing about 4 percent of all cancers in sugar gliders. We should learn the results of the diagnostic testing tomorrow, and are keeping our fingers crossed that the masses are benign.

When I got home around 2:00 p.m. from our 10:00 a.m. appointment, M scooped Virga out of her travel pouch and Virga spent the rest of the day sleeping in M's sweater.

Virga enjoys a mealworm snack this evening from the comfort of M's sweater

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Update on Virga

It's been a week since we had Cirrus and Virga in for their checkups and our vet found two masses near Virga's pouch. She has has been on an antibiotic and an anti-inflammatory to treat her for mastitis, and there seems to be improvement.  She is back to her usual self in the morning, being the first (or quick second) out of the pouch for her yogurt. While the others are napping in my shirt during night play time, Virga runs on the wheel.  M has been checking the masses and says they seem to be getting smaller. Virga has been very good about taking her medications. I use a small syringe to give her just 0.2 ml of her meds, and it requires holding her so she can't squirm and can't bite, though she hasn't tried to nip me. I think she is sort of resigned to the fact that we have to do this twice a day, and just like a kid she gets a treat after taking her medicine.

So, we're hopeful that there is continued improvement and things go well next week on her next visit to the vet.

3 Hours at the Vet

Today we had an appointment for Virga and Cirrus for their annual wellness check.  They are now almost nine years old.  We also had another reason for taking them to the vet. She and Cirrus have had a brown discharge around their pouch, and it seems to have been bothering Virga some.  She will frequently spend several minutes grooming and cleaning her pouch. We had taken her in for this before, and the vet indicated it was the result of glandular discharge related to hormonal activity and was fairly common and not usually a problem. So, we were expecting much the same result today.  Cirrus, always curious about what is going on around her, was active and awake once we got into the exam room, so she was first up for her checkup.  She is doing great and weighed in at 79 grams.

Virga was sleeping comfortably in the pouch when I had to scoop her out for her exam. Both she and Cirrus did pretty well with Dr. Whitington, squirming as they usually do but overall being well-behaved all things considered.  As part of their exam the vet took a swab from their pouch to check for anything unusual.  When Dr. Whitington took the swab from Virga, we were all surprised to see blood on the swab. She was a little concerned about it, but indicated that the blood was likely the result of the swabbing but also said there was some irritation. As she continued the examination, she found two masses near the middle and side of the pouch. Dr. Whitington indicted they seemed to be mammary in origin and wanted to examine Virga's pouch and the masses more closely. This would require general anesthesia and about an hour to complete, including lab analysis.  We told her to go ahead and headed out to wait with a very unhappy Cirrus.  She did not want to be in the bonding pouch, especially by herself. For most of the hour she kept trying to push through the mesh, to the point her normally pink nose was red.

About an hour and 15 minutes later Dr. Whitington brought a now awake Virga out to us and filled us in on what she found. Virga's pouch was irritated and inflamed, and she could see one mass through the pouch. The other wasn't easy to see. Dr. Whitington suspects the inflammation and masses may be due to mastitis.  Virga is on an antibiotic (Trimethoprim-sulfa) and an anti-inflammatory (Metacam) for 14 days, and then she goes in to be checked. If the medication doesn't help, then the next step will be to do a biopsy and go from there.

Needless to say, we were pretty bummed out by the news.  In hindsight we could note some small changes in her behavior.  She is normally the first out of the pouch when it's yogurt or mealworm time, and lately she has been slower to come out.  However her appetite has been good, her weight has been stable, and she has been active (spends a lot of time on the wheel). On a positive note, the vet said that Virga is in otherwise great shape.

Virga came though the whole exam very well and curled up to sleep in the bonding pouch once she was brought out. Cirrus was pretty stressed out the whole time, but finally relaxed on the way home.  She is spending most of play time tonight napping in a fleece blanket.

Another Scare

Sunday is usually "weigh day" for the gliders. We wake them up for some yogurt, coax them out of their pouch, and weigh each of them.  This Sunday was no different, except that we got a late start and did get around to weighing them until around noon.  Often we have to turn the pouch out to get each of them out, usually Foehn and CB. I had weighed Cirrus and Virga, and M said I might as well scoop the other two out. I reached in and eased CB out of the pouch, but he was the only one in there. Foehn must be in the other pouch in the cage.  I went to get her and found that pouch empty.  Odd.  I checked a fabric tunnel hanging in the cage (part of their February Valentine theme accessories) and it was empty.  OK, maybe she was in the pile of blankets on the floor of the cage. As I shook out each blanket without a sign of a glider, a horrible feeling swept over me. I checked the cage doors and they were all closed and latched...except one door on the end next to the wall, I had cleaned the cage Saturday and when I moved the cage back into it's spot I didn't latch that door. It could only open about an inch because of the wall, but that's all the room she needed. I went into the office and told M what I found.

In past "adventures" we had discovered their escape early enough that the gliders were still active. In this case it was after noon, and Foehn, wherever she was, was probably curled up asleep and would not be out and around until after 10:00 pm.  We started our search upstairs.  Their winter theme cage set was on the floor waiting to be washed, and I was hopeful that she had found her way to the familiar smells there, but that would have been too easy. No dice. Assuming the worst, we headed downstairs to the basement. There were signs on the stairs that she had been that way. Finding her in the middle of the day among all the stuff down there was a needle in a haystack proposition at best. Although we didn't say anything to each other at the time, both M and I felt this might be the time that wasn't going to have a happy ending. We started looking through boxes of fabric that M has downstairs, and through other boxes that she might have climbed in.  I headed over to the utility area to check the sump well, and was relieved to not find her there. The last time she and CB headed downstairs she was over on that side of the basement.  However, it was going to take hours to try and go through everything systematically, and even then we could miss her.  M came over to my side of the basement and we were not quite sure where to begin. M noticed droppings near a shelf, so we started checking the boxes.There was box of M's old clothes on a shelf and as she started going through it I heard her exclaim "Well, there you are!"  Foehn was curled up in a box of M's old clothes, probably a familiar smell to her. M said she looked up at her as if to say "What took you guys so long??"  We gathered her up and brought her upstairs to join the rest of the gang.  She was a bit dehydrated, so we got her some pedialyte and juice which she readily lapped up for the next hour or so. She was glad to be back with the rest of the gliders and they all happily went to sleep once the excitement was over.

We were very fortunate, first that we found her so quickly (about 30 minutes of looking) and second that she was the only one to leave the cage.