Saying Goodbye -- How Do I Know When It's The Right Time?

[Courtney]

Nova has a growing oral tumor. She is approximately 2.5-3 years old. Due to the placement, the vet has recommended that we leave it and simply keep her comfortable until it impedes her ability to eat and drink. If I opted to remove it, it would mean taking a good portion of her lower jaw and I'm not willing to do that to her for the sake of a few more months. So far, she is still eating, drinking, and begging for attention like normal. I can touch the area and I clean it up every morning with a wet q-tip to make sure there’s no food caught. From what I can see, the way it is growing is not affecting her tongue mobility at all. Her tongue is still where it should be and has not been displaced by the tumor.

Despite all this, I’m worried. I know they hide pain well, and what if she’s in pain? How can you tell? I cannot see any signs that she’s suffering – I’ve moistened her kibble and she is maintaining her weight. She wheels every night, noses around her toys and run laps around her cage. She looks happy and interested in her surroundings. When I open her cage, she is always there to greet me and lift her chin for a quick rub.

I guess I don’t want to prolong her life if she’s suffering, but I also don’t want to cut it short if she’s still enjoying herself. Every other hedgehog I’ve helped cross the Bridge has told me exactly when they want to go, but none have had such an obvious tumor growing in their mouth. How can I tell? My vet has told me that the only option is euthanasia… but cannot estimate when. He trusts that I will do the right thing for her when the time comes, but how will I know?

 

[smhufflepuff]

Your situation feels very familiar to me. Satin had a SCC tumor in her lower jaw. She had bright chearful eyes right up until the end. She ate her RC babycat and maintained weight and wheeled. She snuggled. And burrowed.

Although she never winced or raised a quill, I surmised it hurt her because she'd wait several minutes after her pain meds before she started eating. Ultimately, she was no longer able to eat her favorite food: mealies. She still attacked them vigorously... just couldn't eat them. Julie sent along a few waxies... which she enjoyed greatly.

We talked a lot about how it was okay to go. We read from the Tao of Pooh. We snuggled. She pushed her little jaw up against my fingers. I think it felt better with a little pressure.

I knew it was time when she pooped out a waxie almost intact (she'd swallowed it whole); she could not chew. I knew it was time when she drooled in her sleep. I knew, for sure, it was time when I found no poop on her wheel or on her pudgy little feet.

I'd make sure your little one has some meds for pain. I'd give her love.

Know that you will know when it is time. And know that we'll be here for you when that time comes.

 

[Courtney]

Hmm. That's the confusing part... I've always assumed the physical hint of pain in a hedgehog was runny or green poop, or a complete lack of. Every morning, her wheel is coated, as are her feet. Her poop is solid, perfectly shaped and the usual color. Nothing appears amiss and she eats with a great appetite. As soon as I put her bowl in her cage with food, she's on her way over to have a snack. I've added a little bit of water to her kibble, just enough to soften the crunch out of them but not enough to make it so she doesn't have to chew. She will refuse to eat if she feels her food is too mushy. I've watched her eat and she works her way through her bowl of moistened kibble just as quickly as ever. As far as I can tell, she doesn't favor the side with the tumor - she's just as likely to chew her kibble on that side as she is the other.

We've had quiet discussions, Nova and I, about when it would be time to cross the Bridge. I ask her how she's feeling and I sit quietly because I know she will tell me. I can sense that she's not quite ready to go yet, but I don't want to prolong whatever pain she might be feeling.

Is there another pain medication option for hedgehogs aside from Metacam? It's proven to be very unkind to my hedgehog's stomachs, even when mixed with food, and I'd rather avoid any form of upset if I can.

Even though I know it won't fix the issue, I've considered contacting her vet and asking if he can remove the bulk of the tumor that he can see while leaving her jaw intact. On one hand, I think it would make her more comfortable to have the majority of the growth gone from her mouth. On the other hand, it seems like an awful lot of unnecessary pain for her. I know she's not ready to go yet and I'm not ready to make that call for her, but I would like to keep her as comfortable as I can until she tells me what she would like to do. I'm just at a loss as to what the best course of action would be -- daily pain medication until the end, or a one-time surgery to clean up the bulk of the tumor. Neither will cure her and neither will buy more time... but both will make her a little bit more comfortable for the time she has left.

 

[smhufflepuff]

From what my vet tells me, removing part of a hedgie's jaw is not such a good way to go. It doesn't really buy hedgie a lot of time and causes plenty of pain/struggle while hedgie is still alive. Kind of sounded like a good way to torture a hedgie before s/he dies. On the other hand, we did talk about debulking the tumor with Satin. Although we didn't go that route, it did seem like a decent option. I think your vet will probably have the best idea - being able to see the tumor, having a sense of his/her own skill at addressing it, etc...

We used Piroxicam instead of Metacam. I put acidophilus on her kibbles and administered her meds in an oral syringe in which I'd draw up babyfood, meds, more babyfood. And she did pretty well that way in terms of tummy upset. I don't know if it's any easier on hedgie bellies... but it's, at least, a different med.

We went with the Piroxicam because there was some research that suggested in might slow or stop the growth of squamous cell tumors -- the kind Satin had. I don't know if it helped slow it, but it did seem to have an effect on pain - and for that, I am grateful. Do you know what type of tumor Nova has?

Not favoring which side she chews on... same with Satin... which was wild because, by the end, her tiny teeth were loose on the tumor side and her jaw was not in good shape The only clues that she was ever in pain, beyond me projecting how I'd think I'd be feeling if I had a tumor that big, is that she'd wait a little bit in between getting her Piroxicam and starting to eat her kibbles.

 

[Kalandra]

Knowing when it is time is the hardest part of caring for these guys. Sometimes its very clear very quickly. From what you describe your little girl is still doing ok, and she isn't ready yet.

My SCC girl was doing great. She didn't eat hard food, but ate mealworms, baby food, canned food with gusto. She ran on her wheel. Her weight stayed normal, and she was HAPPY. She met me with a smile and loved to snuggle with me.

I took her out to go cuddle while watching a movie late one evening. She was fine when we started our cuddle. Two hours later I went to put her back in her cage and her eye was bulging. By morning it was worse and she was obviously no longer happy. The tumor had spread and was pushing her eye out. In two hours we went from life is still good, to things going down hill fast. We said our good byes that morning.

Its never easy making the decision. And you will second guess yourself many times.

 

[Courtney]

Thank you both. I can't remember exactly what the vet told me it was, but squamous cell sticks out in my mind. I took her in on suspicion of cancer, but in hopes of an abcess. I remember leaving, knowing full well that my girl had cancer. I just can't remember exactly what the vet said. That was in November, just after I lost both Kismet and Shadow, so I was pretty devastated.

Nova was diagnosed with cancer at the beginning of November and the tumor has been fairly slow growing. When I noticed it, it looked like a little bit of swelling at her gumline and by Christmas, I could clearly see the tumor. Over the next couple months, the tumor slowly increased in size and just last night, I noticed that she had bad breath. Not horrible, but just enough that I was able to notice when I was kissing her nose.

According to her vet, an oral tumor that grows this slowly is encouraging. From the cases he's seen, most tumors tend to grow quite quickly in these animals. He's not sure if the slow growth is due to the care I'm taking to keep the area clean and aggravation-free, or if we're just lucky... but he feels she might be an 'okay' candidate for a quick surgery to remove the bulk of the growth and clean the area. He was quick to add that this was, in no way a cure, but it was a chance at a little more time that she's comfortable. He would not remove any portion of her bone, but would simply snip away as much of the tumor as he could. He also warned me that sometimes, tumors do bleed and there is always a risk of losing a hedgehog during surgery. However, his thoughts were that this tumor would not pose as much risk, simply due to the location and physical appearance of it, and the fact that my daily cleanings have not produced blood. In many of the cases he's seen, tumors of this stage have bled with little contact or when the animal eats... and Nova has not bled at all. More encouraging is the fact that the tumor is contained to her lower jaw... there is not even a hint of swelling around her eye and the 'lines' of the tumor have not extended further up or back than they were when he first saw her. It's grown larger forward and out, but not up and back. So, he's hopeful and willing to perform the procedure if I ask him to... he has left the choice to me.

So, I have some thinking to do. I asked Nova what she wanted and her answer was to wiggle her nose at the dog, burrow into my shoulder and make little snuffling noises at my hair. When I returned her to her cage, her first stop was the food dish and then she proceeded to scurry around her cage, take a bathroom break and crawl under her liners. To me, that was a clear sign of "I'm not done playing yet!"

 

[Courtney]

Nova's tumor has doubled in size over the last day and a half, and she has started to rub her face on any surface she can. She spent nearly 2 hours last night, pushing her jaw against my thumb and whimpering quietly. She is still eating and moving around, but she looks a little off-balance (which I'm guessing is due to the tumor throwing her off). She is still alert, playful and affectionate... but I can't even pretend that she's not hurting.

I brought her to work with me today, in hopes I could find a vet office near my work and take her on my lunch break so she wouldn't have to suffer any longer. I spent the morning calling around to various vets in the area, to ensure they would be willing to euthanize a hedgehog with anaesthesia, and allow me to be present during it. I came across one vet who told me, "we do not offer those comfort options to pocket pets. We will euthanize them for $12, but will not use anaesthesia on them because it's too expensive. She won't need it anyway, because the euthanasia will cause cardiac arrest and she will die quickly. Anaesthesia would be a waste for a small animal and she won't even know if you're there or not."

As you can surely guess, I will not be setting foot in that particular clinic. Despite my desire to spare her any more suffering, I have opted to take her to her regular vet tomorrow instead. That gives me one more night with her and I can be assured that her passing will be stress-free and dignified.

 

[Kalandra]

Courney, I'm so sorry to read this. But from the sounds of it, you are making the right decision. Give her lots of love tonight.

 

[cindyv3737]

I'm so sorry Courtney. It sounds like you are making the right decision. Give her extra loving from me.

 

[lillybug29]

I'm so sorry! I can't imagine the pain you're going through. I'd be devestated if and when anything would happen to my Khaki.

 

[summerdays]

i'm so sorry to hear you are going threw this, its never easy when our babies get ill.

 

[Courtney]

Well... I took her to the vet at 2pm today. I spent all evening with her last night, and then the entire day today. I put the vet off as long as I could, in hopes that I would start to feel more sure about the entire thing. Normally, I can justify that I'm doing the right thing and I feel okay with it... I didn't feel that way with Nova. Every time I thought about euthanizing her, my stomach tied itself in knots.

When we got to the vet office today, both Nova and I were shaking. I was absolutely terrified of what was going to happen that afternoon, and I think Nova was picking up on my nerves. In an effort to calm my nerves a bit, I asked the vet to do a quick exam on Nova and see if we were really dealing with a tumor here instead of a really, really bad abscess. I know vets are highly trained, but they can be wrong too... and I needed a second opinion.

My heart nearly stopped when the entire mass popped out of Nova's mouth. As soon as the vet stretched Nova's cheek aside for a better look, the entire growth fell out of her face. It was about the size of a kidney bean and it fell out with no effort at all. The lines were clean. With a q-tip, the vet cleaned a bit of pus from the site and the area started to bleed clean, bright red blood. As a testament to how easily this thing came out, Nova was wide awake. She hadn't been sedated yet and I was holding her in my hands. During the entire process, she did not flinch or ball up... she didn't even hiss.

After the vet wiped away the blood, she asked to take Nova into the back to sedate her and run some x-rays. She warned me that Nova could pass away during that process. A little while later, she brought Nova back and invited me to look at the x-rays. From what she could see, Nova's jaw was in perfect shape. The bone was intact and healthy, and all the surrounding teeth were in good shape. It appears that the growth was on the outside of her jaw, kind of in the pocket of her cheek and hadn't extended into her sinus cavities. The nasal bone was pristine. She's missing about 4 teeth where the growth was, but when she began to examine the loose growth, she found them inside. The growth will be sent off for testing.

When she brought Nova back to me, she told me she couldn't believe the spirit of her. She was already fully alert and trying to run around the table. She wasn't sure how long it would take for the bleeding to stop, if it did, but it had pretty much stopped by the time we left the office. She also mentioned that she couldn't be totally sure about the growth until it came back from testing, and that there was a chance it could some back quickly. She gave me Baytril and Metacam anyway, and told me there was a chance it was an abscess. There's also a chance it's a tumor, but at least we know we tried and explored all options. Like she told me, Nova has nothing to lose. She was going to be euthanized today, but she got a bit of a miracle. If the growth comes back, I'll be able to euthanize her with the knowledge I did everything I could. If it turns out to be a massive infection, at least I know I didn't act too suddenly and she didn't die needlessly.

Long story short, Nova is home with me, her mouth is a little swollen, but she's as chipper as ever. She's currently snuggled in a blanket on my lap, watching me type this while she pushes a corner of the blanket around with her nose. Her cheek is a little distended, but the bleeding has stopped completely. Her quills are relaxed, she breathing calmly and I feel good about the decision. I got a bit of a miracle today.

 

[ChinnyMom]

i am so happy to hear that Nova is ok! )

could you please share the name of the vet that refused to use anesthesia. being as i am in Edmonton too, i want to ensure i never go to that vet! (although i have chins and not hedgies, this is a good thing to know).

 

[smhufflepuff]

Holy poopboots! That is absolutely amazing. I'm sending many good vibes up to you and Nova. Wouldn't it be amazing if she made a (near-)full recovery? I'll be hoping that's the case. Either way, I am so happy that the two of you have the evening together! Let's pray for more to come.

 

[Courtney]

I'm being cautiously optimistic. She was investigating her food dish about an hour after I brought her home and looking very disgusted at the prospect of a completely mushed up diet. She took her medicine very well and I don't see signs of fresh blood around her mouth. Poop is still in good form, but I expect a bit of loose poop soon. She's in great spirits, despite her experience today and is as curious as ever. So far, so good.

 

[Kalandra]

Courtney, that is an absolutely amazing story. From all you had told us before, it sounded like your vet was positive that this was oral cancer and there was no hope. From your last posting, it really sounded like she was in bad shape. But it is always good to have a vet do a final exam before euthanizing them to confirm that they cannot do anymore.

You absolutely must update us when those results come back. At least the two of you have more time.

 

[Courtney]

Kalandra, I was absolutely stunned when the mass just fell out. I've had quite a few hedgehogs with cancer, and this thing looked exactly like a tumor. It looked like every tumor the vet had ever seen and he's one of the best hedgehog/exotic vets in Edmonton. All signs pointed to cancer - the only oddity was the fact her health was not declining at all. The mass was growing, but Nova was still acting normally.

The vet we saw yesterday is one we don't normally see, and when she met Nova, she was very surprised at how alert she was. The unsteadiness on her feet was gone and I'm wondering if she was experiencing some balance issues due to the tumor. She was zipping around the exam table and the vet was quite surprised. Most animals who come in for euthanasia are more lethargic, especially with a tumor of that size in their mouth. Even though the growth looked a lot like a tumor, Nova was not acting like the typical patient. She was very upset when they vet picked her up and she was absolutely appalled when the vet had the nerve to put her in a basket to weigh her. However, she sat quietly in my hands when the vet started manipulating her mouth.

There's still a good chance the growth is cancerous, but we won't know for sure until the tests come back. The way it just fell out of her mouth is not typical of a tumor, but strange things can happen. Right now, I just feel very thankful that Nova has a bit more time. When I checked on her this morning and gave her more pain medicine, she was looking great. Her mouth was looking less swollen and there didn't seem to be any new blood coming from the area or in her cage. I saw that she had eaten some of her mush last night... not as much as normal, but enough that I could see a sizable bit missing in her bowl. She was fighting the syringe (which I'm really happy about) and as soon as I put her back into her cage, she scurried to the other side and glared at me from behind her wheel.

I will definitely update with results when I have them.

 

[Courtney]

Here is a photo of Nova's mouth today, just over 24 hours after the growth fell out. As you can see, her eyes are bright and she looks quite animated and happy. I actually had to gently scruff her to get the photo because she was on her way to explore and there was no way she was posing for a photo.

 

[Kalandra]

Courney she looks great. Her mouth does have a bit of a stretched out look to her lip, but gosh she looks just amazing.

 

[Courtney]

Thanks, Kalandra. The stretched out look is slowly going away too. Her appetite is really good too... I'm having a bit of a hard time measuring how much food she's eating, since I'm mushing up her kibble, but if I had to guess... she's up to at least a tablespoon, maybe a tablespoon and a half of mushed up food. I've been putting a lot of water in it and she's been meeting me at the cage door whenever I replace her food. Her poop is a little darker than normal due to the medicine, but I'm guessing the amount of food she's eating is helping keep the loose poop to a minimum.

And she eats FAST! I should have taken a picture yesterday -- she was so hungry that she had food on her snout, right up between her eyes. She was slurping the kibble-water down, chewing on some of the larger chunks and just going to town on her bowl. Her tummy was nice and full this morning. I watched her for about 10 minutes last night as she was eating and she wasn't favoring the 'bad' side of her mouth at all.

We're going to the vet today for a follow up and a few more pictures... I think the vet will be very surprised at how well she bounced back.