|
8th
November
I received Buddha the Bare-Nosed Wombat into care after he had
been in care for approximately two weeks with another carer.
The carer noted that it was incredibly difficult to feed Buddha
and didn't think that he had gotten enough milk into him during
the period he was in care.
On
presentation Buddha weighed 1.46kg. He was a bit boney. His
abdomen was very, very hard and he was sucking his penis most
of the time. Tried to offer a dummy and cover up cloaca, both
with no success.
9th
November
Buddha weighed 1.56kg (different set of scales). Poo very hard,
like little pebbles.
Buddha
will not drink from a bottle. Feeding him with a syringe, small
quantities at a time as he becomes quite distressed when given
too much. Only 10mls to 20mls per feed. Feeding every hour or
so. Buddha - looking healthy but is really very sick.
10th November
I noticed that Buddha was having difficulty urinating. A lot
of straining with very little output. He was grinding his teeth
a lot, indicating pain.
11th
November
Buddha weighed 1.57kg.
Started
on Bactrim antibiotic for five days. Vet was reluctant to give
Baytril as he believed that it can damage growth plates in young
animals. Also gave one Vitamin C tablet in water to help dissolve
any crystals if there were any. We could not collect enough
urine for analysis. Given Pain Stop daily for pain relief.
12th
November
Started offering Buddha small amounts of Cystitis Relief to
help stop urine burning.
15th
November
Buddha seemed to be constipated so gave a 9ml enema of water
and oil. Pass some softer poo later that day. Buddha weighed
1.55kg (weight loss).
16th
November
Started to flush Buddha with as much fluid as possible to help
dislodge any blockage or crystals. Given a total of 123mls,
including milk.
After
five days of Bactrim there was no improvement so with the vets
advice we moved to Baytril (Tim Portas from Australia Zoo advised
that it was fine to use in marsupial joeys and was actually
quite successful). Baytril injectable given for the next 6 days.
17th
November
Buddha weighed 1.59kg. Thought to be water retention and not
healthy weight gain. Offered a total amount of 133mls in fluids
including milk.
18th
November
Buddha's poo is now quite soft and smells a bit peculiar. Not
like thrush though. Poo dark green and thick. Although Buddha
was reluctant to drink fluids he was keen on eating grass, I
believe that the poo change was in relation to the amount of
grass he was now eating.
Offered
a total amount of 135mls in fluids including milk.
19th
November
Buddha weighed 1.61kg.
Offered
a total amount of 157mls in fluids including milk.
Was
advised by another vet that Pain Stop might actually be making
the cystitis worse. Changed to daily Metacam (cat), twice a
day. Was told that this might also reduce inflammation in urethra.
20th
November
Buddha given 10mls of sub-cut fluids.
Visited
the vet again to advise that there was no improvement. Buddha
given valium to help relax the muscles in the hope that he will
pass urine. Didn't work, only made him anxious and bitey for
some time. When that wore off he slept soundly for a couple
of hours.
During
his whole time in care with us Buddha only slept for a couple
of hours at a time at the most. Mostly shorter periods. He wanted
to be held at all times and only settled when being held. If
put in his pouch in the wombat crate, he would wake up, get
out of the pouch and scratch at the box. As this was too distressing
for him we carried him most of the time.
Offered
a total amount of 115mls of fluids including milk. This is all
we could get into him.
We
were being advised to get in as much fluids as possible but
at about this time we wondered if it was actually beneficial.
Fluids going in but not coming out - could this lead to damage
of the bladder?
Benn
Bryant of Western Plains Zoo advised to get an xray ASAP. Asked
the local vet but was advised that it couldn't be done as they
were too busy and to ring back on Monday to see when he could
be booked in. Rang another local vet and was told to call back
on Tuesday.
Rang
the Koala Hospital and spoke with Cheyne Flanagan. Organised
to go to the hospital on the following Tuesday (that was the
next day their vet would be available) for a complete host of
tests including xrays, ultrasounds, blood and urine.
21st
November
Found another vet who was willing to take an xray. I was advised
that if the bladder was swollen or extended it would be seen
in an xray. Was advised that the bladder was not swollen or
extended.
Buddha
given 5mls of sub-cuts.
22nd
November
Buddha weighed 1.67kg.
23rd
November
Rang vet to ask for a sedative for Buddha as he wasn't sleeping
soundly. We were going to the Koala Hospital on the following
day and wanted Buddha to sleep the night. As he was distressed
without our security we had him in his pouch in bed with us
and he was keeping us awake most of the night. We wanted Buddha
to sleep so we would be refreshed to drive to Port Macquarie
from Armidale. Was told that there was no therapeutic benefit
so sedation was not approved.
Another
vet was in the clinic and looked at Buddha and advised that
he probably had a blockage and needed urgent treatment. They
wanted to keep him overnight to do some kind of procedure that
would cost us $500. I told them that I was going to the Koala
Hospital the following day for a host of tests and treatment
for free so they decided to try to catheterise him and drain
the urine from his bladder.
I
left Buddha with them for a couple of hours while they did the
procedure.
When
I received him back they told me that they were unable to catheterise
him although they had tried several times. They thought they
saw crystals on the catheter so flushed Buddha with Walpoles
solution. 20mls of sub-cuts were given.
They
performed Cystocentesis and removed 63mls of urine. I was told
that when they removed the needle there was so much pressure
that some urine went under the skin when the needle was removed.
I was distressed to learn that the two procedures were done
without any anaesthetic.
I
was told to give 5mls sub-cuts every hour if there was no urine
output and 10mls of sub-cuts every hour if there was urine output.
I
brought Buddha home and noticed that his abdomen was even more
swollen. He started showing signs of extreme pain - hissing
and writhing. Urine was seeping out of the hole in his belly.
He started gaping for air.
Buddha
died painfully, within the hour of bringing him home from the
vets.
Autopsy
Results
The
history and findings post- mortem are most suggestive of a long-term
bladder dysfunction, resulting in limited ability to void urine
and distension of the bladder. Histology and history indicate
that the urethra is anatomically patent, ruling out a stricture.
No
evidence of crystals was found histologically or grossly.
It
is not surprising that catheterization was challenging- the
lumen of the urethra in an animal of this size is very small.
There
is no evidence of a bacterial cystitis and changes in the bladder
are more indicative of inflammation due to trauma / distension.
In the absence of a visible primary cause, a neurological deficit
must be considered likely.
In
the absence of proper neurological control, urine accumulates
in the bladder and distends it. This can lead to diffusion of
toxins through the bladder wall and, in some instances renal
compromise, though there was no histological evidence of kidney
injury here.
The
presence of protozoal cysts in the lung is interesting. These
can occur without affect in many cases and their impact on the
lung lesion in this case is a bit doubtful. They might, however,
offer a possible cause for neurological dysfunction as they
can sometimes lodge in brain or spinal tissue.
There
was some very minor evidence of inflammation in the brain but
no evidence of cysts in the single brain section examined. Toxoplasmosis
can occasionally be acutely fatal, especially in marsupials,
which have not evolved with this sheep / rodent / cat-spread
protozoa.
In addition to being a potential cause of bladder dysfunction,
this is also a possible cause of death, or contributor to death
in combination with aspects described below, but investigating
this will require some more searching through these tissues.
In a young animal such as this, a developmental defect also
cannot be ruled out as a cause of neurological bladder dysfunction.
Leakage
of urine from a cystocentesis site is rare and in this case
is probably due to the fatigued state of the bladder as a result
of chronic distension (the bladder would normally contract around
the needle hole, closing it off).
It is normal procedure to do cystocentesis without sedation
or anaesthesia unless the animal is struggling, and cystocentesis
would have been a valid course of action in this case - with
such a massively distended bladder it is important to both remove
the wastes and to remove the pressure on the bladder to allow
it to regain its ability to contract and function. (Note: WPZ
later advised Linda that anaesthesia should be given to wildlife
for this type of procedure).
Leakage
of urine into the abdomen is rarely acutely fatal as in this
case, though irritation can result in abdominal discomfort.
Death from bladder rupture is primarily due to reabsorbtion
oftoxins from the urine, which normally takes some time to reach
toxic levels.
It
appears possible that death resulted in this case because the
animal already had high levels of toxins in its blood from its
chronic urinary tract dysfunction but this cannot be confirmed
without serum biochemistry taken close to the time of death.
|
