# Large growth discovered under right shoulder.



## GoodandPlenty (Feb 4, 2012)

Today (Monday, 3:30 pm) I discovered a *large* lump under Sophie's right shoulder while giving her a full bath (soap and everything, which she gets every six weeks).

The lump is round; almost a perfect ball; smaller than a golf ball, but not by much. 
Firm, but yielding to the touch; not hard or 'rock-like'. I don't know what I am feeling in the firmness? Cell growth under the skin? Fluid filled and the firmness due to swelling?

It does not appear to be causing Sophie any pain at this time - including when I touch the lump or lightly press on it. I did not try to find out at what point of manipulation she might feel pain. I only handled the lump enough to get an initial judgment regarding size and depth. It is almost perfectly round and also ball-like; that is, it 'feels' like it has a depth in proportion to its roundness. In other words, this is a large lump, IMO.

This lump was NOT visible, palpable, or in any way noticeable to me on late Saturday afternoon (just two days ago). She got a standard mini-bath on Saturday (three a week, water and brushing only) and it just happened to be that that day's 'spa treatment' was belly rubs, chin rubs, and ear rubs. If it was there in any substantive way, I would have seen and/or felt it. I don't video all of her mini-baths, but just happened to decide to video that one because I was working the getting her used to handling her jaw and lips a bit more during bath-time.

*Just how fast do different kinds of lumps develop/ What are likeliest causes? I understand that a condition can be hiding out of sight and then - bam! But two days ago this was not visible and today it is huge.*

She just passed a full vet exam just a couple of weeks ago; 26 August. CBC plus additional blood test markers all good. UA came back good. She was, however, diagnosed with gingival hypertrophy (possibly epulides); excessive growth of gum tissue.

Surgery to remove the excess growth and test the removed cells is planned to happen about three weeks from now. The vet feels fairly confident that the issue will turn out to be non-cancerous excess cell growth and that everything will be fine. I've withheld getting too excited about that because I have more reason to fear the worst than she does. She handles exotics but is not a hedgehog specialist.

This situation changes everything of course. I am, of course, concerned that it is an immediate emergency and that there is high chance that Sophie's time is short. I am sending correspondence to Sophie's vet tonight and expect that an appointment will be prioritized, but am looking get some opinions, likelihoods, and odds before I get there. The glass is looking half empty and leaky right now. I'm open to positive outlooks, but need *honest opinions.*

*Videos below:*

lump-discovery-14-09-15
(Monday - Full bath today, with Aveeno body wash and everything. Full baths are given every six weeks. Mini-baths three days a week (no soap).
(16:33 - First link picks up at 9:50, when I notice that there is problem with Sophie.)









lump-discovery-c-14-09-15
(5:06)





belly-and-chin-rub-14-09-13
(Saturday mini-bath with belly rubs, chin rubs, and ear rubs. No indication of a problem was seen or felt.)
(10:12)





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I discussed her recent vet visit here:

http://www.hedgehogcentral.com/forums/11-health/75250-vet-visit-exam-experience.html

I discussed her upcoming surgery here:

http://www.hedgehogcentral.com/foru...s-gingival-hypertrophy-possibly-epulides.html

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## Nancy (Aug 22, 2008)

My guess is it's a lymph node. My Tessie had a lump in the exact same location and hers was a lymph node. When she was gassed to check it out it was also discovered she had a huge oral tumour under her tongue. We did not wake her back up nor proceed any further diagnosing of the lymph node. 

Tessie's seemed to appear out of the blue. Once I discovered it, it was very obvious and I'm sure had it been there for more than a day or two either my daughter or I would have seen or felt it. 

It may be Sohpie's lymph node is just enlarged because of what is going on in her mouth. Hopefully that's all that is happening but this certainly is tipping the glass towards empty. :sad:


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## CoffeeKat (Jan 15, 2014)

I can't add anything constructive to this alarming turn of events, except to say that I share in your sense of dread in what this may mean, and hope it turns out to be nothing serious. Sending lots of positive energy to you and Sophie.


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## gracefulchaos01 (Mar 19, 2014)

I'm with Kat. You and Sophie are in my thoughts. Your postings have been so very informative and I appreciate you sharing your experience.


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## Kalandra (Aug 25, 2008)

Tumors can seem to appear out of no where. I have had hedgehogs that we were closely monitoring for a tumor regrowth. Monitoring in the sense that every time they were in my hands I was feeling around for a tumor. I’ve seen them quite literally appear between morning and evening check and go from seemingly nothing there to a tumor the size that you are showing in those videos.

You want honesty, well while we will all hope that it’s just an infected lymph node caused by the other problem she is having, I tend to assume it’s a tumor/cancer and then am pleasantly surprised/relieved when it isn’t. I’d be back to the vet, have an FNA done initially to determine if the mass is solid or not and I’d opt to send it away for pathology if it wasn’t clearly an angry lymph node or infection. I’d also discuss the location and possibility of removal. I’d also ask if using prednisone would be advisable. I have had lots of tumors removed from hedgehogs and the couple we have had removed from the neck and face were the most complicated as lots of nerves run through those areas, nerves that control facial motor functions like blinking.


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## GoodandPlenty (Feb 4, 2012)

Thanks everyone. I want to go in as knowledgeable as possible so that I can be better prepared for what to expect and what decisions might be best made 'on the spot'.

Her regular doctor won't be there, but her surgical doctor (for the excess gum growth issue) will be seeing her. Her specialty is oncology. I've never met her but know that she is fully informed on Sophie's situation. 'Officially', she is Sophie's vet because she is also their exotic specialist. Her regular doctor has always been in charge (or at least the public face of it) because email correspondence has been between us, then presumably shared as needed.

We have an appointment for tomorrow. I'll get another good look at her this afternoon.


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## Amandarrella (Jun 13, 2014)

I hope every thing is ok and we will be keeping Sophie in our thoughts


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## GoodandPlenty (Feb 4, 2012)

Video of Sophie's lump today, Tuesday, 24 hours after discovery on Monday afternoon. The lump was not visible or palpable on Saturday afternoon.

I don't think that the lump is much larger, but it must be some amount larger, because it is more obviously visible. I think this is the best quality video yet at showing and describing the lump, but it was clearly more visible today than yesterday, whether video quality is improved or not.

The lump neither looks nor feels larger to me, but is must be because it somehow seems clearly more prominent. I would say that the mass beneath the lump is more 'defined'; still softish, but I'm pretty sure that it is firmer.

No indication of pain from Sophie so far. We'll see the vet tomorrow and I'll be sending them this video tonight, though I don't know how useful it will be as far as adding advance information to the vet.

lump-discovery-d-14-09-16
(8:40)





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## Melanie G. (May 29, 2014)

What a sweet hedgie! I'll be thinking of you and Sophie.


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## Nancy (Aug 22, 2008)

Once we know the lump is there, it becomes very obvious and just about impossible to tell if it is getting larger. That's why photos are so important. 

From your videos, I would say if it's larger, it's not much larger. When she is standing, does it hang down? Tessie's hung.


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## Nancy (Aug 22, 2008)

How did things go today?


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## GoodandPlenty (Feb 4, 2012)

As you can imagine, it has been a long and difficult day, not helped by the fact that I did not sleep at all last night. I worked late, read for a while, did the day's cage maintenance at like 6 am . . . .

Sophie started out well. It's an hour drive each way and every once in a while she would pop her head up out of her sack and sniff around, checking things out.

She lost ground fast after we got there - also typical. Less aggressive with the huffing and chuffing, but no less balled up and quick to pop the whole time we were there.

The final tab for her full checkup was $335. The estimate for the proposed surgery and biopsy, which I had decided to go ahead with was $425 to $545, with the surgeon's time being the most variable part of the estimate (as I would expect). I'm super-tired, but am pretty sure that I've linked these documents in this thread, or one of the related ones.

This all started as a single, detailed post, in which I was just looking to give people a perspective of what they might expect with a complete checkup. When the gingival hypertrophy / epulides diagnosis came out of what was supposed to be a routine check-up, that became Part 2, so to speak. The emergency of a huge growth below her shoulder from out of nowhere has put Part 2 on hold and turned out to be Part 3.

Below is today's bill - $360 - which puts me in for $700 for two visits in three weeks, and one more visit, at a minimum, yet to come. Note: I've blacked out some non-essential details in the body of the bill that would likely confuse the average person because they won't be in a position to understand the context of what is being said. Several people in this thread (and others who may be watching it) would understand exactly what is being said, but I trust these same people understand my reasoning for making some minor redactions.

I think it is important that everyone be able to see sets of actual vet bills, which is why I started the first thread on the subject of what a 'typical' vet visit might be like. Of course, I had expected it would be just the one thread - the complete checkup visit and everything coming up fine.

The additional issues have added two threads to Sophie's little adventure, doubled the expense so far, and added a level of heartbreak I cannot even begin to quantify. Still, this forum is the place for people with a serious interest to come to for information and these are some of the things that they need to be aware of.

*Today's bill, page 1:*
http://www.serenebreezes.com/Sophie-docs/vet-bill-biopsy-copy-1.pdf

*Today's bill, page 2:*
http://www.serenebreezes.com/Sophie-docs/vet-bill-biopsy-copy-2.pdf

At the bottom of page 2, I see that I have been classed as "Regular Cliente" - not something to aim for.

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Now - to get down to the consultation / discussion. It has helped tremendously that I have always corresponded with Sophie's vet(s), professionally, and in a well-organized, thoughtful fashion in advance of each visit; i.e., they have learned that I am a serious person and we don't waste time framing the basic issues on exam day. I'm looking for a higher level of knowledge / service / progress. Sophie officially has two doctors now, and time is the one thing they don't have enough of. Advance preparation / information has helped us all to make the most of our time. The value of that cannot be overstated.

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The vet did start with an FNA (Fine Needle Aspiration), for which I was not charged. She did a thorough job of attempting to find fluid pockets within the mass (whether infection, water, blood . . . anything) but was unable to find fluid pockets. She ran several slides on the spot and ruled out infection very quickly. She also went a long way (without fully committing) to ruling out lymph node issues / defects. (I don't fully understand what she was saying about that, but she is an oncology and internal medicine specialist and was quite confident.)

She was clearly disturbed and perhaps even surprised by the condition of the tissue within the mass and went right to the edge of declaring the mass as likely cancerous on that basis alone. I don't think that I can quite capture the context of her comments here, nor do I care to recollect it at this time.

Again, I suspect that the relationship and mutual respect that has been built over time made a lot of difference in what she was willing to say and how she was willing to say it. Additionally, though, her FNA slides indicated a large number / percentage of 'uniformly sized round blood cells', which I didn't understand very well but took to understand as a strong indicator ath the biopsy is going to come back as a cancer. The type of cancer and the options are open questions, but certainly not encouraged to think positvely.

She did the biopsy part of her procedures essentially as a 'multilevel core sample'; essentially drilling into the mass and extracting a number of samples. As an oncology specialist, she is may be freer (by qualification and experience) than another vet might be, to walk right up to the edge of diagnosis without biopsy results in hand. She is nearly 100% certain that the mass is cancerous; highly suspicious of a direct relationship to what was initially hoped to be a minor procedure with the excess gum growth; and feels near certain that that issue of excess gum growth has already worsened on the upper-left side of her mouth. In Sophie's original check-up, the upper-right side of her mouth was much worse than the left. It appears that what was supposed to be a standard check-up exam has simply coincided with the development of a fast growing cancer(s).

The biopsy results are critically important. They will provide specific details as to type; aggressiveness; chances that removal is possible (or not) - vital decision making data.

My expectation, based on what I was directly told, and what was indicated between the lines, is that surgery is extremely unlikely to be a reasonable option: money; life expectancy; quality of life . . . .

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The vet was very impressed with the last video link that I sent, in which I did my best to get a close view of the growth under her right shoulder, to show it from multiple angles, and to palpate the growth so as to show size and consistency as best as possible.

Because Sophie was a ball of quills by the time she got to the examining room, no useful exam was possible. After knocking her out, she could do much of what I did in the video, but specifically said that it was very helpful to have my 'live action' manipulation and demonstration of her condition. I had not yet even asked if the videos were proving helpful. She made a point of bringing up the subject and that this advance information was helpful and gave her information slightly different than what she could get with Sophie knocked out.

My correspondence included excerpts from comments made by Nancy and Kalandra. I made clear that these were thoughts and impressions expressed by highly experienced hedgehog enthusiasts who are not vets (and make no claim to be) but know enough to talk to vets in their own language. She specifically mentioned that these excerpts included in the correspondence where were well informed and went on to make the further point that they were "well phrased".

Near the end of our consultation I mentioned Nick Trout's _"Tell Me Where it Hurts: A day of humor, healing, and hope in my life as an animal surgeon._ (2008) Through pure chance I recently read this book, and made this comment in our correspondence.Early on in the read I keenly felt that I must be one of those pet owners that veterinarians dread putting up with. That feeling remained with me even as I finished and shelved the book. If I am one of 'those people', please don't feel a need to be professionally polite to a fault. Sophie is the priority and if my questions and interests burn precious professional time, it's okay to tell me to f&#8230; off. (That probably won't 'cure' me, but I'll do my best not to be a problem, which I suspect that I am.)​I told her I hoped that I wasn't "one of those people". It meant a lot when she said 'No, because you are too humble to presume or pretend that you know more than you do.' I believe it is tremendously important to 'know what you don't know'. That is, if I don't know something I say so and go looking for how to find out what I need to learn. It was nice to find that she sees that. In the end I have to make the decisions, but I am paying for her expertise, relying on her candor, and intend to learn as much as possible at the same time.

I didn't get the impression that she merely being polite. My take was that we have an understanding, a complementary relationship. They know medicine. I know hedgehogs in general and Sophie in particular. That is a relationship that money can't buy. It is a relationship that mutual respect makes possible.

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I asked about how much experience she had with hedgehogs specifically, noting that very few vets probably ever have the opportunity to have a significant amount of experience, even if they are exotic pet specialists. She was very honest in saying that she had less experience than she would like with hedgehogs - in large part because owners rarely invest in treating hedgehogs, even if a cure is likely.

She mentioned removing an eye. I know that Sophie's other doctor has overseen a broken leg. But it was pretty sad when she related that the bulk of her experience with hedgehogs was treating for mites and making recommendations regarding treating obesity. These are the kinds of issues that I often describe as 'owner error'; that is, conditions that were either entirely preventable, or could have been intercepted at an early stage.

The percentage of hedgehog owners that take even minimal preventative care is evidently pitiful poor. The average hedgehog owner resists costs beyond the exam charge (in an area where people are fairly well off). Because hedgehogs often have to be knocked out to even look at them, that instantly more than doubles just the basic exam cost and people just won't do it.

It was made very clear that I am a highly committed owner and she is very happy to have a hedgehog owner that is willing to commit to a certain level of financial and emotional investment. It was nice to get that feeling, because I am in constant worry about decisions made and those to come.

The takeaway - most hedgehog owners should not be hedgehog owners.

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When Sophie had serious diet induced cystitis, I rejected two treatment options / recommendations. In part, because of cost. In part because I did not believe they were the correct courses to take. It turned out to be the correct call. Continued research did ultimately bring me to a solution and cure. One path would have been expensive and identified nothing. The other would have been unnecessary, invasive, and unhelpful.

The takeaway - even highly educated professionals have to make 'best guesses. I was invested enough to risk being wrong in trusting my own judgment.

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It will take up to two weeks (hopefully less) for the biopsy results come back. (Which seems like a long time for something so important. WTF? Sophie is not currently in pain, but I certainly am!)
Well, she's in some pain. I will be giving her Metacam by oral syringe for the next several days. We've done this before, so should get in the groove pretty quickly.

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The biopsy was taken as kind of a 'core sample'. One small hole, requiring just one stitch to close. The stitching material will 'self-destruct', so no stitch removal will be necessary. Though the incision is 'small', it is pretty ugly to look at right now. I don't know how a single stitch is all it needs. It looks much worse than I had expected. I got my first look at the biopsy wound when giving Sophie her first dose of Metacam. I scruffed her and quickly saw that it is going to be important to restrict flailing of the left leg. She could tear that wound open. It was an unexpected surprise today and I was pretty much already committed to getting her dosed and off to her cage, so Day #1 of Metacam was not what I would call hugely successful. It went okay and I've no reason think that she hurt herself any, but tomorrow I will be taking extra care to restrict potential movement of her front-right leg. That will be tricky, because she is an expert at batting the syringe away at the last second. She's like Kung Fu Hedgehog or something. Always has been.

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Because she has an exposed wound, Sophie has been banned from mini-baths for a minimum of two weeks, so I'll have to work out a temporary alternative to keep her feet, toes, and nails in decent shape. I'd like to keep her quills as decontaminated as possible also, but mostly she may just have to be on the dirty side for a couple of weeks. Certainly I could work in new habits, but it would almost certainly take longer to implement them than a couple of weeks, so probably not worth going to a lot of trouble for. Her feet, toes, and nails - at a minimum I'll need to go Plan B for those.

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The biopsy results could show any of several things and my biggest question was the likelihood of being presented with definitive options - will the choices make deciding yes or no relatively easy - or am I likely to get trapped in a 'best guess' scenario where the choice is an expensive gamble or a brutally pragmatic decision. The vet was pretty direct that she felt that results would be definitive and the choices clear; another indicator to me that she is giving warning for a cancer that will ultimately be fatal. I am hoping the tests indicate a timeline. I want her to be happy and active for as long as possible, but am going to be cautious about prolonging life. People suffer horribly every day because of money, religion, bureaucrats . . . at the whims of people who should have no right to any say whatsoever . . . . Not me - and not Sophie either.

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*VIDEO:*
Metacam dose and a short view of biopsy wound (though not close enough for a good look). I was concerned about her flailing leg aggravating things, so may not have struck the best balance of controlling the situation today. I'll be better prepared to control movement of the that leg tomorrow while she is scruffed and maybe getting some closer video of the biopsy location as well.
scruff-metacam-a-14-09-16
(1:24)





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## Kalandra (Aug 25, 2008)

I'm surprised by the 2 week turn around for the biopsy though. The lab that my vet uses often gets at least a preliminary back within a few days. Hopefully the 2 week ETA is worse case scenario and you'll have answers sooner.

Keep strong and doing what you are doing. You seem to be very focused on the right things, keeping Sophie's best interest as top priority. There are plenty of us out here who have been there before and are very willing to share our experiences with you, if they may help.


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## CoffeeKat (Jan 15, 2014)

I can only imagine the heartbreak you are feeling, the sense of dread and the pain. This should not be happening to Sophie. We know how much effort was put into finding her breeder (no wait, that was Erizo who talked about that...are you by chance one and the same person?) We know how meticulous you are with diet and care. If any hedgehog should live to be 9 years old, it should be Sophie. 

One thing I have learned since ripping off a piece of my heart and giving it to a hedgehog, is that these little critters are truly "heartbreak pets". I naively thought that all it takes to guarantee a long and happy life is proper and conscientious care, especially in the area of diet and nutrition. Now I know that the operative word here is "naive" and your experience brings that home with a bang. I have this sickening feeling that all of us are doomed to deal with something like this eventually, and I wonder if it's because the APH gene pool is closed, since hedgehogs can't be imported (that could be an ignorant and erroneous observation, because it just popped into my head without any research or facts).

Regardless, thank you for taking the time to document this sad journey. I hope in some way it was and is cathartic for you. This is valuable information for those who take the time to read it. It goes without saying but I will say it anyway: please keep us posted. Stay strong and proceed with what must be done without the emotional baggage of woulda shoulda coulda, knowing that you have given Sophie the best possible life. Hope for the best, prepare for the worst.


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## GoodandPlenty (Feb 4, 2012)

> I'm surprised by the 2 week turn around for the biopsy though. The lab that my vet uses often gets at least a preliminary back within a few days. Hopefully the 2 week ETA is worse case scenario and you'll have answers sooner.


I was shocked when she said up to two weeks, and yes, that is worst case. Probably the early side of next week is a reasonable expectation. However, apparently it can take two weeks often enough that they aren't comfortable quoting less. That's understandable - for something so serious they don't want to say one week and then have owners unexpectedly worrying for even longer.

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> (no wait, that was Erizo who talked about that...are you by chance one and the same person?)


Well, between us we are "one and the same". It depends on how you are scoring. GoodandPlenty is my account. At some point way back when my girlfriend made the Erizo account because she'll sometimes answer questions about cage setups, and also hedgehog behaviors. From my computer, I tend to just use the accounts interchangeably. If on her laptop, it only has the Erizo login credentials stored.

I know it sometimes confuses people. Not only are we commenting about the same animal and cage setup, but we write in very similar style. (If a post is long and overly detailed, it is probably me, David. We are both writers, and yes, I suppose that Tina is the better editor. Because of our research background we both tend toward more detail than less, but I am much worse about that.)

Combining the accounts has been mentioned before, and she is okay with it, but I've always resisted. She should be able to have her own account. Any muddying of the waters is mostly my fault, though. Especially because Erizo isn't exactly 'her account' when I post on both of them mostly randomly.

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## MomLady (Aug 14, 2010)

About the pathology lab time table--my vet uses a lab in California, she said it was the only lab that did a good job with hedgehogs. I think my results took about 10 days.

Keep strong and I know this is heartbreaking.

This may sound new-agey and weird, but there was a 2 week delay before my Nara could have her spay-hysterectomy surgery. (She was getting pain meds and an anti-inflammatory in the meantime, which I think may have helped the results.) 

Anyway every night when I had her out for cuddles, I told her she was going to have the "bad stuff" taken out and it would hurt and she would be scared. But I would be waiting for her and she could go home, she just had to fight and be strong. I was very anxious due to her being almost 4 years old. Well she did just fine and she had her 4th birthday in July and we just celebrated the 4th anniversary of her adoption. 

She is a big girl--almost 700 grams--the breeder said she was going to be a big girl--parents were big too. She eats like a little piggy--always has. She even liked the metacam--it was some fruit flavor. 

I am just relaying this to give you some hope. Some might have said due to her age, not to bother with the surgery, but it seems like your Sophie has a lot of fight left in her.

My thoughts are will you. I am so sorry you are going through this. 

ML


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## CoffeeKat (Jan 15, 2014)

Been thinking about you and Sophie a lot. How is she doing? Has the growth increased in size?


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## GoodandPlenty (Feb 4, 2012)

Update for Sophie:

I am presently on hold for biopsy results. I'm really hoping they come back next week; most likely, but not a certainty. There really isn't anything to be done except to monitor her until then.

She was given five days' worth of Metacam to minimize pain from the wound resulting from the biopsy. The doses come premeasured, so one syringe for each day. I would usually prefer to draw my own doses, but that just the way they do it. I did get them to give me an extra dose just in case.

One problem with exact dosing is that there is no extra. If she jerked her head just as I fired a dose, that dose could be lost. If I lost control of the scruff she could spit out the dose and it could be lost. I would rather pay for extra and discard remainder than have no margin for error. It is a one hour drive each way to the vet, so I can't just pick up extra doses. The animal hospital here (small town) would accept her prescription, but their practice doesn't typically use Metacam and would have to special order an entire bottle. A vet that uses Metacam regularly can portion full bottles into smaller bottles or vials.
This is always something to keep in mind with medications. If you have animals that have never been scruffed and dosed, or owners that have never done it, the likelihood of wasted doses is pretty high.

We've done this before, so that helps, and I've scruffed less cooperative animals before which also helps. At any rate, we are doing great. Today was Day #4 of the Metacam, so if tomorrow goes well, then I'm fine with seeing the extra dose go unused.

Note: Even if the animal takes to scruffing pretty well and even if the owner is pretty good at doing it, keep in mind that some medications are more trouble to deliver than others. Because Sophie scruffs pretty well, and I have some experience at it, I am able to scruff pretty lightly and become more aggressive only if need be. I would not recommend starting too gently for inexperienced animals or owners. If the animal becomes agitated, then you've a problem. Better to start with a firmer approach and back down as you both get more experienced / comfortable. Because hedgehogs are instinctive first, 'soothing' one that becomes agitated is not likely to be successful.

Note: Sophie did great when she was getting Baytril, but has never liked Metacam. Also, she tends to 'froth' the Metacam, which I would prefer to see her lick and swallow as much of as possible. For this reason, with Metacam I hold her upright for longer than I would otherwise. It forces her to swallow most of the dose. If I put her to her feet right away, she would very likely spit out as much of the Metacam as possible. For this same reason, holding her upright for a minute makes it more likely that she will like her lips and swallow most of the frothing. Tomorrow is the last day for Metacam, Day #5.

The last couple of days I have made no effort to inspect the growth / tumor. I have, however, taken good close looks at the biopsy location. On the first day just getting her dosed was our limit. The last three days, I have added biopsy inspection and gotten good close looks. The wound is larger than expected. It is no wonder that she is banned from her mini-baths for two weeks at a minimum. The vet described it as a "core sample", which is a good description. It looks like they drilled an auger into the tumor and that it was pretty good size around.

Note: Sophie's mini-baths are banned for at least two weeks in order to keep the wound dry and to prevent seepage from the outside to the inside. In order to keep her routine as normal as possible I have made a radical change to the mini-bath itself, but a change that allows me to retain most of our 'routine'. Maintaining as much of her normal routine throughout this process may have bonus benefit in the coming days or weeks. One of the things we do during her three-a-week mini-baths is incorporate a 'spa treatment' - either a petting session, or belly rubs and chin rubs. She seems to really like these things, so adapting the mini-bath to retain these other elements could extremely helpful at reducing stress now and in helping to keep stress minimized overall.

Except for a drastic reduction in water, everything is the same with her mini-baths, right down to brushing her feet and legs and brushing her quills. The big change is that instead of having her in 4" - 5" of water and being pretty generous with decontaminating her quills with a good brushing - I have her in a about 1/2" of water and am drawing tiny amounts of water onto her brush from a bowl that I have set to the side. We've done two of these now and I'm pretty pleased. The 'cleaning' is not particularly good, but a little cleaning is better than none, and it maintains the general routine that lets me continue her 'regular spa treatments'. For whatever reason, she ONLY allows these during bath time, so they are pretty important.

Her feet, paws, and legs get damp, but no part of her is 'wet' and I am very protective of the tumor and incision area. Her vet hasn't seen video(s) of this adjustment to her mini-bath, but unless I'm missing something, I have met her concerns and my concerns, and minimized the changes to Sophie's routine. Additional changes will be made as needed / directed.

Although she continues to show no pain as a result of the tumor or the biopsy, there are enough required changes going on that I believe minimizing them wherever possible is an important thing to do.

On the plus side, of course, one hole for the biopsy equals one stitch. A standard incision would have been far more invasive, left a much larger wound, required several stitches at least . . . . In other words, I ain't complaining.

Today I did try to add tumor inspection after checking the biopsy site. It went okay, but not great. She was a bit agitated and once an animal is agitated, backing off is often not possible. Still, she did let me size the tumor and palpate the area.

The size appears unchanged; about the diameter of a golf ball. Maybe smaller, but not much. The mass definitely seems firmer, but is not 'hard'. there is much less 'give', which to my mind eliminates that it is filled with fluid. The FNA already confirmed this anyway; the vet made several insertions, specifically looking for fluid pockets (in addition to taking cell samples). Note: That day's bill wasn't cheap, but the FNA and all of the slide inspections related to it were done at no charge. None of that even appears on the bill. It was just something that we talked about. One of the benefits of building relationships over time. Nothing is cheap, so she probably did me quite a nice favor at how she handled that.

It helps also that she is dealing with an owner that is willing to invest what they can reasonably afford. She had previously lamented, quite honestly, how disappointing it is that most hedgehog owners won't invest anything in their animals; another reason that hedgehogs are an inappropriate pet for most people.

Below are all the related videos taken so far that I've felt worth posting. Some of them have been linked previously, but this is a kind of round up of videos taken to this point that have been posted.

The videos are taken: (a) for my own benefit and comparison. (b) for my mother who lives in Charlotte and always enjoys seeing Sophie's videos, even though these aren't the kind we like to see. (c) to provide visual information to Sophie's (vets) during our advance correspondence preceding each visit. (e) for anyone here that is an interest in following the details of this kind of thing.

Regarding (e), it's a narrow subject that only a few people will have an interest in, but documented accounts of discovered tumors, treatment, progression, options, decisions . . . they are hard to come by and people need to know about these things.

*VIDEOS:
*
lump-discovery-14-09-15
(16:33) 








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lump-discovery-c-14-09-15
(5:06)




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belly-and-chin-rub-14-09-13
(10:02)




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lump-discovery-d-14-09-16
(8:40)




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scruff-metacam-a-14-09-16
(1:24)




..............................

vet-a-14-09-17
(1:36)





vet-b-14-09-17
(1:09)




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scruff-metacam-b-14-09-18
(3:40)





scruff-metacam-c-14-09-19
(5:53)




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restricted-bath-b1-14-09-20
(6:54)





restricted-bath-b2-14-09-20
(9:34)




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scruff-metacam-d1-14-09-20
(4:21)





scruff-metacam-d2-14-09-20
(7:18)




..............................

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## CoffeeKat (Jan 15, 2014)

Thank you, David, for taking the time to reply and keep us up to date on Sophie. You're right, this topic and the details will not be of broad interest but there will come a time when this information will be of great value to a worried and frightened hedgie owner. And there are a handful of us who simply ARE interested and concerned. The videos are valuable as well, especially as it relates to the proper way to scruff...I have seen pictures of scruffed hedgehogs that looked as if their little eyes would pop out of their sockets because the skin was pulled so tight too close to their head. I don't know if this has ever happened, but it looks terrifying for the animal. Thank you for sharing.


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## GoodandPlenty (Feb 4, 2012)

NOTE: Bad news and graphic. Do not read further unless you are ready for that.
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Biopsy results are back and Sophie's vet called to discuss the situation.

This is just going to be an overview because that's all I can manage for now. There's not much else to say anyway.

"Soft tissue sarcoma". Source: from connective tissue. It would take additional testing to arrive at a definitive or highly likely conclusion regarding the source point / tissue, and there is no justifiable reason to pursue this.

Locally aggressive tumor. Does not metastasize quickly or easily. It is very unlikely to have spread at this early stage. Due to the extreme local aggressiveness of the tumor, she would likely die, or be suffering horribly, long before the spread of the cancer became a factor in any way.

Surgery is an option, but would be major big deal with a poor prognosis. This particular type of tumor is resistant to removal. The tumor is large and that alone poses serious issues due to the invasive extent of the surgery.

It is also a type tumor that cannot be removed in its entirety because it is very likely continuing to grow off the main mass in 'tentacles'. The likelihood of removing all of the cancerous cells and getting clean margins is near zero. Without a reasonable certitude of complete removal of the tumor and achieving clean margins, radiation therapy would be required in order to try and kill the remaining cancer cells.

If every effort was made, the prognosis would not be good and Sophie would suffer terribly. The cost would be thousands of dollars, but that is not relevant in this situation because I would not allow the procedures even if they were free.

Even if surgery and radiation were a complete success (highly unlikely), the suffering does not justify the procedures. When all was said and done, for what additional lifespan would she likely have a good quality of life? Not enough - if any.

It was hoped that the Metacam would help her increase food consumption, but it remains down significantly; about 60%. I will be adjusting her diet to increase energy density; more ground kibble and meat based canned cat food, and decreasing the vegetables.

Sophie's vet is not optimistic that this will gain her time. She continues to gobble down her pinky mice and mealworms because she loves them. She is skipping her main food because although she has always liked it just fine, she just doesn't really want to eat anything that isn't an absolute favorite now. A shift to a high percentage of meat and ground kibble may inspire her to eat more - maybe not. It will increase the energy density of what she does eat, which will help some, for a while.

Sophie is officially considered a hospice animal now. For however long her quality of life seems to be pretty good we'll keep to our usual routines; take our naps together with her snuggled up under my shoulder or into my side, belly rubs . . . .

When she shows signs that life is difficult, painful, or in any way becomes unacceptably problematic, then I will make the decision that our run is over. The vet estimates the low side of one to two months. Sophie will not see her third birthday.

The vet will be emailing details of how to best put her down. I have stipulated that I must be present. I'll know more about that soon enough.

Sophie is set for a 'petting session' this afternoon. Depending on how it goes, I'll post a video link.

So far I'm doing the things that need to be done, and making the decisions that need to be made. I expect to run out of gas before long. I'll update Sophie's progression, but don't expect too much.

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## Kalandra (Aug 25, 2008)

I'm sorry to hear this. We dealt with a spindle cell sarcoma many years ago with one in a similar location. Very young hedgehog too. He was only 1 yr 1 week at first symptom. We visited Michigan State University Onocology to get options, and they were the same. Surgical removal and daily radiation treatments for just short of a month with a high chance it would come back. Hospice was the direction we took as well.

RE Diet: Often we switch to a low carb, high fat/protein diet with cancer patients. Whether or not it slowed the cancer I have no idea. But they did tend to like those foods better.


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## CoffeeKat (Jan 15, 2014)

I'm so sorry to hear this news. I hope you can take some small comfort in knowing that you gave Sophie an amazing life, and now you can spoil her with all her favorite foods. When it comes to the lives of animals we love, quantity does not trump quality. Wishing you strength and peace in the difficult days ahead.


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## gracefulchaos01 (Mar 19, 2014)

I'm very sad to read this prognosis. I only hope that there is some comfort in the knowledge that these last days will be filled with much love between all of you and an opportunity to say good bye.


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## Melanie G. (May 29, 2014)

I am so sorry. That is really sad news. Take care of yourself and cuddle Sophie. We're thinking of you and Sophie.


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## MomLady (Aug 14, 2010)

You and Sophie are in my thoughts.

Take care of yourself and your precious girl.

Hugs, 
ML


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## GoodandPlenty (Feb 4, 2012)

When I began this thread, there was no predicting where it might go. Sadly, it is tracing an account of where there was zero indication of a problem on a Saturday and Sunday - to a huge tumor from out of nowhere on Monday - to biopsy surgery on Wednesday - to confirmed (and expected) test results of terminal cancer this Wednesday.

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Perhaps some people will benefit from an accounting of the decline and eventual euthanasia of an animal that was thought to be in generally quite good health. This is how fast things can change.

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Sophie is expected to have one to two months of a mostly comfortable life remaining. Realistically, I would be surprised to see her make a month before I make the decision. In part, because a week or two too soon is kinder than realizing I've waited too long.

Also, since the onset of her tumor, *consumption of her main food has crashed*; down 60% - 85%. It's an odd extreme. Sure, pinky mice and mealworms are her favorite foods, but we've always done exceptionally well with maintaining a balance of foods and nutrients.

I've kept her right at 3.0 grams of mealworms for a long time because it is such a small percentage of the total diet, but she knows that she has to show me wheel time and food consumption to get the bonus pinky mice.

She continues even now to love the pinky mice, which I hand-feed in the late afternoon. Her only reticence is safety. She is such a scaredy-cat about being out in the open. She continues to hunt down every one of the mealworms that I put out during her late-night visit.

She's always liked her food blends; preferring some over others but always eating well and taking in plenty of premium kibble (ground) and meat-based canned cat foods and my using vegetables to tweak down the energy density to keep her weight steady. Her vet(s) have been pleased with the nutrient balance

Her vet is now quite concerned, that for whatever reason, the sudden massive drop in the food blends that she has always eaten plenty of is likely the next stage in deterioration. Taking away her two very favorite foods is unlikely to 'force' an increase in eating the healthier and better balanced food blends. Though behaviors are almost all entirely normal, and though she is in no apparent pain and still eating her treat foods, she is just running out of gas. Taking those away will more likely lead to her giving up eating. At this point, a drop in interest in her treat foods or a complete refusal to eat her main food, are probably the key signs to intervene swiftly and prevent suffering.

The plan is to keep the mealworms exactly as they are, and to manipulate the pinky mice to see if that prompts a change or not. Today, because she ran for just over 2 hours last night on the treadwheel, she got a pinky mice splurge; three mice totaling 7.9 grams (a lot for her, even when healthy). Depending on what happens tonight, the plan is to minimize the pinky mice tomorrow and hand-feed just one at around 3.0 grams and monitor.

Her food blend has been revamped to increase energy density: 5.0 grams crushed EVO (high-protein, high-fat compared to most kibbles), 16 grams Natural Balance Turkey & Turkey Giblets Formula, 6.2 grams BeechNut Peas, and 1.6 grams water to thin consistency,for a total available weight of 28.8 grams. Three weeks ago this percentage of ingredients would have had her gaining weight at a mind boggling rate. It would have been the stupidest idea ever. But that was then. Today we need maximum energy density in whatever amount she is willing or able to eat.

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*For those wondering about euthanasia:*

Though most vets won't allow owners to be present at any procedure not easily done in the primary exam room (fairly unsophisticated and not well equipped - used for the most basic things only), it is very common to bring what ever is needed for euthanasia into that room so that the owner can be present. That was a non-negotiable requirement for me.

Her vet sent me an email today outlining the process.



> Hi Mr. Blackwell,
> 
> Per our conversation yesterday I have detailed the euthanasia process and the associated costs below. Please let me know if you have any questions about this. We could complete the entire process in the exam room so you could be present the entire time.
> 
> ...


I already have a place to bury Sophie and also have everything that I could want with pictures and videos. My only need is to be there. It is my responsibility. This is a pretty good overview of the process . It does not note how emotionally traumatic it is likely to be, but I assume they are well experienced with possible reactions.

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*Most recent videos:*

scruff-metacam-e1-14-09-21
(1:53)





scruff-metacam-e2-14-09-21
(11:18)





belly-and-chin-rub-14-09-22
(23:59)





tumor-inspection-14-09-23
(14:18)





restricted-bath-c1-14-09-25
(6:42)





restricted-bath-c2-14-09-25
(13:50)





pinkies-14-09-25
(7:51)
(Three pinky mice (7.9 grams). She ran just over two hours last night, but consumption of her primary food was down about 85%. I decided to treat her extra with pinky mice today.)





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## ellisrks01 (Mar 25, 2014)

I just want to say, I have been following your thread and I'm really sorry about your baby.


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## gracefulchaos01 (Mar 19, 2014)

My heart weeps for you. I ask the universe to offer you the strength you need to make it through these trying times. Not just now, not just when it's time to put her down. But for as long as you and your family need it. It's very obvious you care deeply for Sophie and her leaving this life will cause change on many levels. 
I hope that, for as long as you can, you have a willingness to stay here on the forums as well. The knowledge you share is invaluable to many of us. And please know, we share your sorrow as well.


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## Nancy (Aug 22, 2008)

I am so sorry you got such devastating news about your beautiful little girl. At least you have a short amount of time to spoil her rotten and love on her. 

Reading your vets euthanasia plan I'm wondering if rather than putting her back in the box after she is given the injection, they could use the tiny mask and hold it close to her nose. By using the mask, you would be able to stroke her face, rub her ears or whatever petting she enjoyed. She would pass feeling your hands rather than in the box. All but my first have passed with me and usually my daughter as well, stroking them and telling how much he or she is loved.


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## DesireeM81 (Jun 14, 2014)

I, like the above poster, have been following in close detail. I can't imagine how hard this must be for you. But I appreciate your knowledge and willingness to be upcoming with procedures and your experience. As hard as it is for me to think of my little ones passing, I, now, have something to help when the time comes. 

Thank you and again I am so sorry.


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## Lilysmommy (Jan 7, 2009)

Chiming in to agree with other posts - have been following as well, and I'm so sorry about the news. It's the hardest thing to hear that there isn't anything that can be done. I'm glad you have a bit more time with her to let her know how much she's loved, and treasure every minute. 

When I had to let Lily go, she'd been under anesthesia earlier in the visit, which was when we realized there was a large mass in her abdomen & how quickly it'd grown (hadn't been there 10 days before). My vet let her wake up so I could have a few minutes with her, to cuddle & say goodbye. They were always fantastic about letting me right there anytime she had something done - I was allowed into their back treatment room numerous times to oversee mouth checks, etc. done under anesthesia. After I had a chance to cuddle & tell her I loved her, my vet used the tiny mask to put her under again, and I was able to hold her the entire time. I wouldn't have wanted it any other way - it's why I chose to let her go right then rather than risk waiting too long at home, or losing her on the surgery table. I still have no regrets at all.

Give Sophie some extra love from the forum. I'll be sending you many good thoughts for the coming days.


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## CoffeeKat (Jan 15, 2014)

Kelsey, you were so young to go through this. I can't imagine how devastated you must have been. I just want to say thank you for staying active on the forum and helping so many of us with your knowledge and experience. David, I hope you can do the same because you have much to share, and we all have much to learn.


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## GoodandPlenty (Feb 4, 2012)

*Update:*

Sophie remains on hospice watch. Best guesstimate was one or two months, but we all know that could become one week or six months. There is a lot known about this tumor because the vet got a great 'core sample' for testing, but progression, even with ideal care is not predictable.

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In her favor, it is a type that is slow to metastasize, so spread is unlikely and if that happened it would probably lead me to a decision to euthanize immediately due to the greatly increased risk of pain as well as highly increased risk of 'emergency level deterioration' at any moment.

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Euthuanasia paperwork was sent to me by PDF so that is all set, and the billing for the procedure has been prearranged. When the time comes, whether an emergency due to a fast developing change, or a planned appointment because of slower deterioration that brings me to a scheduled decision - we will go in directly to an exam room. No paperwork, no sobbing at the front desk while paying. Everything is prearranged as much as possible.

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Working against her is that the tumor is locally aggressive and has even grown a bit, particularly up under the jowl. The entire tumor is firming up, but she has full leg motion so running is unimpeded. In fact, running time is up a modest amount, but at a slightly slower average speed and a much lower maximum speed. So she's doing well with quality exercise. The increase in running is a pretty good percentage, but everything about the runs seem reasonable - no sign of being caused by negative stress.

Because her computer is remotely located, I can see that she is running about twice a night, at about 30 - 35 minutes each. Those are good numbers to see.

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Working both for and against her is her main food blend. Though she has loved it and eaten heartily, consumption remains down significantly. It has recovered a bit and the the blend has been adapted to be high-protein, high-fat, high-nutrient. The 'filler' vegetables that she used to need to keep from gaining weight have been dropped completely, so every bit of her food blend is energy and nutrient packed.

She still loves her mealworms and still loves her pinky mice. The weight of pinky mice fed in the late afternoon depends on how well she ran and ate the night before. We want to encourage maximum consumption of her main food blend (the best nutrient mix), but a quality of life decision has been made to not reduce her mealworms or eliminate her pinky mice (which she still loves, loves, loves) in order to try and 'force' her to eat more of the primary food blend.

There is zero guarantee that would work. She could quit eating entirely. So the most we are pushing for on that is a reduction of pinky mice weight following 'bad' nights, to *try* and help push the primary food blend on following nights.

Yes, at best, her total weight of mealworm and pinky mice is now higher than it ought to be, but she is on hospice watch; is going to die in some number of weeks; and we'd rather she have less weeks of total lifespan and more weeks of good quality of life.

If she defies the four to eight week best guess projection, then maybe we will revisit manipulating nutrition options. That cannot be predicted or expected and we'll just make those kinds of decisions as needed. The cancer is terminal and time is expected to be shorter rather than longer. Quality of life is a higher priority than length of life. Every single day and every single week is a bonus right now. We and she are making the most of that.

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Her daily schedule / routine is mostly unchanged. We had to make some choices (and took some minor but real risks) on handling needed changes to her mini-baths for two weeks. Because of the open wound from the biopsy, mini-baths had to be adapted in a major way to protect the wound and limit infection risk.

There were a couple of hard choices there, but we went with absolute-minimal-water mini-baths (as close to 'fake' baths as possible) in order to fully retain the regular petting sessions and belly rub / chin rub sessions that have always been a part of that routine. It was a priority decision.

There was some calculated risk, but great care was taken, and it all worked out fine. The biopsy wound closed very nicely and is completely healed over. She can again have her mini-baths in a fair bit of water as was usual. The stitch is 'self-destructing' and hasn't dropped off yet, but no big deal.

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We have added a new 'routine' each afternoon. So as not to disrupt her regular routines any more than necessary, I most ignore her tumor as much as possible at all times and just handle her normally and treat her normally.

However, between my office and her cage, I have set up an 'exam station'. We stop there every afternoon on the way back to her cage and I scruff her and get a good look at her tumor; feeling for size, palpating for firmness; testing for pain . . . . It's a pretty short stop, and we are both getting better at it every day. I video every session so that I can watch comparisons if necessary. *Remembering* what I saw last week isn't the same as *visually comparing* as needed.

She is learning that this tumor examination is simply another daily routine. I tend to be too gentle with the scruffing and she is a master at batting at me with her feet or backing away from me, but it's no big deal. And doing this as a separate routine eliminates the likelihood of ruining another routine for her because of a big change and added stress.

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*Recent video:*

tumor-inspection-f-14-10-01

*(6:36)*

Very good inspection of tumor and biopsy location. Just a bit of petting at the end which helps to ease agitation.

The tumor inspection has been added as its own routine so that it does not interfere with any other established routine. Just a short look at size and firmness. Not much to see really, but probably pretty graphic for anyone that hasn't been through it.






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pinkies-14-10-03

*(5:24)*

Three pinky mice totaling 8.1 grams; probably a record amount. But she earned it. Just over an hour on the wheel last night and ate 11.7 grams of her food blend. That's not a huge amount, but is a nice increase from the recent crash and it is her new high-protein, high-fat, high-nutrient blend; no filler ingredients.

There is a lot more added water than usual, so as to thin the consistency for maximum hydration and to prevent the blend from starting to dry out. That was one function of the baby food vegetables.

Therefore, 11.7 grams may not be as impressive an improvement as it sounds.? On the other hand it is still double recent consumption, so a big gain however you choose to calculate the nutrient values.

She'll probably have to take a cut on pinky mice tomorrow. Can't be overly generous every day. This was a big bonus day - not a typical quantity.






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I bought Patricia Morris' _"Blue Juice: Euthanasia in veterinary medicine."_ Though still early in, I'm finding it quite interesting. It is part of Temple University Press' _"Animals, Culture, and Society"_ series.

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## CoffeeKat (Jan 15, 2014)

Thanks for the update. I think of you and Sophie often and wonder how things are going, but hesitate to ask. I know you will be grateful for the amount of quality time you've been able to create by knowing that every minute together counts.


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## gracefulchaos01 (Mar 19, 2014)

I read this earlier today and was somewhat pleased to see that everything is going as well as can be expected. The pre planning for end of life care is brilliant and I was especially pleased to know all of that has been taken care of. It makes being able to focus on the now so much easier. My thoughts are with you and Sophie.


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## GoodandPlenty (Feb 4, 2012)

*Update:*

Hospice watch continues. The tumor hasn't grown much; perhaps a little more growth high near the jowl, right up to under her lower jaw. The tumor continues to become firmer; not hard, but I think less and less yielding.

The growth has not affected her ability to eat. She still gets hand-fed two pinky mice every day and clearly has no functional problem with eating, nor does she show any indication of pain. She is still on the low side of eating her primary food blend. The increase in consumption from the bottom of about 6 grams a night is holding at about 11 - 12 grams a night, and I'm putting all the energy possible into what she will eat. Pre-tumor consumption was about 24 grams, but was energy diluted to minimize weight gain so comparison there is questionable.

I'm having to thin with 6 - 8 grams of water, which is a lot, but she won't eat food that is drying out. I 'reset' the consistency during her late night visit, especially important because the majority of her eating is after 2 am. When baby food vegetables were a part of the blend (low energy density to hold down weight gain), I added only 0 to 2 grams of water.

Most behaviors remain normal. The usual mini-bath, petting session cycle. The usual together time. The usual nightly 'hunt down the mealies' (3.0 grams). The usual napping together.

I handle her exactly the same as usual but have added a 'tumor exam' table. This is a new routine that we do every day. I don't want to upset what she is used to and enjoys by forcing a tumor exam, so have instituted it as its own thing.

She is doing well with tumor exams. Sophie doesn't exactly love getting scruffed and poked at - which is why it is its own thing - separate from all other routines. She does well though and because is a daily thing, she should come round to be better and better with it every day. All behavior or routine shifts have to be considered in terms of weeks or months - never days. Sophie doesn't have months, and probably not weeks, but she trusts me and is doing great.

The one change of note is that after she gets her late-afternoon pinky mice and then runs into her hedgie sack, she has taken to pooping and peeing inside the sack. Pretty much every day. This has not happened since she was six weeks old and still learning about pooping and peeing.

I may be anthropomorphizing, but she looks embarrassed afterword.? No problem though. I know what to expect and when I'm pretty sure she's done, I just swap her into another hedgie sack that I have ready and she crawls under my hand and goes to sleep.

So I do have a definite physical behavioral change, but it's manageable pretty easily. Poop and pee still look fine, so good there.

Her wheel activity is pretty darn good - about 40 minutes a night for a good while pre-tumor. She is holding that and also hitting just a few minutes over an hour with some regularity. That's been a surprise, but the runs seem to be good ones - not panicky, fearful, or concerning in any way. Typically two runs a night of about 30 minutes each at about 1.25 - 1.35 mph (down a bit again). Maximum speed is way down, from solidly over 3 mph to about 1.7 mph, but it doesn't concern me. It is what it is.

*I am concerned about weight loss and that it is complicating when to schedule euthanasia.* I feel pretty strongly that she isn't losing enough weight after considering all the variables. She's lost only a few grams each of the last couple of weeks; just not enough I don't think.? Also, I think that she 'feels' thinner, especially around the belly.

*My suspicion is that as the tumor continues to become firmer, it is taking on what would otherwise be weight loss;* i.e., the firming up of the tumor may be masking what should be weight loss, which, in turn, means that vital organs may not be getting enough energy.?

The original plan was that weight loss would likely be the deciding factor. If she begins to lose weight at a higher rate than I can stabilize, then it would be time. However, if organs are being inadequately supplied with nutrients, this could increase the possibility of a crash; that is, a 'no warning' emergency.

I have an inquiry in with her vet on this subject but haven't heard back yet. *Pending feedback I am leaning toward 'a couple of weeks too soon' and making the decision possibly in the next days.* She was given a four to eight week 'best guess' life expectancy. Sure, she could go twenty weeks and be happy the whole time, you just never know. My position remains that 'too soon' by whatever amount, which can only be guessed at, is better than one day too late. It's an impossible guess.
..................................................................

*Videos:*

tumor-inspection-h-14-10-08

(3:47)

(This video gives an especially good look at the size of the tumor, its condition, and indicates that it does not seem to be painful or specifically bothersome for Sophie.)






nail-clipping-petting-14-10-09

(9:42)

(Good petting session, including extensive petting of the tumor; testing for sensitivity. Several pretty good views of how large the tumor is, though it is much larger in person than what the video shows. It isn't causing her any discomfort or limiting movement. I consider her hospice watch status unchanged.)






belly-and-chin-rub-14-10-11

(10:49)

(Good video of chin rub, belly rub, and ear rub. Clear view of her tumor and comparison from one side of the body to the other. We had a good session, and I was able to massage her tumor a bit. No indication of sensitivity or pain. The tumor is quite a bit larger than it seems from just looking at the video.)






tumor-inspection-i-14-10-12

(4:32)

(Good tumor inspection video. There is voice-over at the end of this video. When Sophie is out of sight, I still have a couple of things to say.)






.


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## CoffeeKat (Jan 15, 2014)

She's lucky to have you, and judging by the trust and affection I see in the videos, you are lucky to have her as well. I admire your realistic attitude in planning her final days, despite the heartbreak it brings. I have a feeling that the information you have been documenting and sharing here will be used for years to come, probably in ways that you can't imagine now. Thank you for sharing.


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## MomLady (Aug 14, 2010)

Thanks for your updates and information. 

I think of you and Sophie often. My thoughts are with you. 

Give her an extra cuddle for all of us here.

ML


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## GoodandPlenty (Feb 4, 2012)

*Update:*

My vet inquiry was responded to by her surgical vet. (She has two vets at the animal hospital that are very familiar with her situation. The 'junior in seniority' vet (newer graduate) is actually the 'senior' vet (in charge) for Sophie's case because she has a stronger strength in exotics and is an oncology specialist (tumors and cancer).

My question was designed to encourage an open and forthright response, and acknowledge up front, that at least part of my question could only be answered with 'best judgment'. I've no doubt that it has helped to establish a relationship with her vets and that they trust: (a) I respect their opinions. (b) I have worked hard to understand the situation, but am very aware of my medical knowledge and experience limitations. (c) I'm on top of everything possible every day.



> Please take a quick look through this and direct to Dr. Xxxxx and/or Dr. Xxxxx:
> 
> *If* Sophie's tumor is somewhat larger (not by lots, but let's say a bit); _* and if*_ the tumor is becoming firmer day-by-day (allowing that it's difficult to know if it is really firmer today than yesterday or to accurately recall the feel from one week to another week); how much 'weight loss' could Sophie be 'hiding' in a tumor that _*may*_ be 'taking on weight' that would otherwise be weight loss? How much vital energy / nutrients could be diverted from critical organs / functions making a 'crash' more likely?
> 
> ...


The vet's response:



> Hi Mr. Blackwell,
> 
> I do feel that the tumor could be gaining weight and masking total healthy body mass loss. I don't feel like I can give you any percentages, but instead would have you try to monitor her body condition as well as her weight. When she is getting her belly rubs does it seem like you can feel more ribs or abdominal contents than before? When you pick her up does it feel like there is less skin and fat in your hand then that also may indicate that the tumor is gaining weight while the rest of her body is losing weight. It does seem like you may also be seeing some of these signs. Unfortunately with cancer we can sometimes see just a slow weight loss without any other obvious changes. This makes is much harder to determine when it is "time." In general we can look for a loss of "pep" or decreased energy level. Unfortunately there is no right or wrong time. I appreciate the fact that you don't want to wait too long, so I guess I would say once you can see that we are on a fairly steady downward weight trend - based more on body feel rather than gram weight - then that might a good "time," since we know that process will only continue on.
> 
> ...


As noted in previous updates, I have added a daily tumor inspection as 'its own thing', an additional regular routine. I have gotten video of as many of these daily inspections as possible. I have come to suspect that I've been correctly judging increasing tumor firmness, but underestimating tumor growth. Going back and watching the earlier videos shows that I have NOT recognized the extent of continued growth - though she still shows no signs of pain or sensitivity.

Today I downgraded Sophie's hospice watch status from week-to-week to day-to-day.

From an email to my mother:



> Vet correspondence below. Her surgical doctor essentially validated my concern that the continuing 'firming' of the tumor is probably masking weight loss as well as unseen deterioration. [Redacted.]
> 
> Yesterday was weigh-in day for Sophie, and I'd expected to see a small loss. Her activity level has been good and positive. Wheel time is actually up from about 35 - 40 minutes to 60 - 65 minutes on quite a few nights, with an even split of two runs of about 30 minutes each. Primary food consumption remains at what I think is a reasonably decent level, especially because it is all energy, nutrients, and hydration (thinned with water).
> 
> ...


I am making weigh-ins daily beginning today. Daily tumor exam before going back to her cage will continue as a daily thing, getting video of as many as possible. You just cannot see some of these things day-to-day even though that is exactly what you are looking for. Video comparisons show a lot of these incremental day-by-day shifts pretty clearly when I look at a two weed old video and then go straight to watching yesterday's video.

I've made the decision that there is almost no possible scenario in which I will try to extend our time into November and am now leaning to ensuring that I err on the side of mercy. I may give us until the week after, but am currently planning to schedule euthanasia for next week.

The video documentation of tumor progression has been a big hit realization - despite careful daily monitoring. Despite that piece of the vet's advice, I am probably not going to wait for her to lose 'pep'. I believe that 'body feel' will be the determiner for Sophie and that we are down to less than two weeks, very likely one week.

This is going to be a long and boring thread for a lot of people - but these are the real life day-to-day things one sees. And also those things that one is looking for; sees; but doesn't recognize because the shifts are so small from one day to another. The review of older and newer videos showed how easy it is not to recognize some of the exact progressions that I am supposedly actively monitoring.
.


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## CoffeeKat (Jan 15, 2014)

Following this thread breaks my heart, but there's no way I CAN'T follow it. When we reach the realization that we can't extend the life of a beloved animal, there's only one right thing to do: just as we give them a good life, we must give them a good death if we possibly can. Death without fear or pain, knowing love and compassion, is our final gift. I'm so glad that you realize this, David, and that you have the courage to make it happen in a timely manner. You, sir, have my deep respect, as do many more of you who are following this thread and who also have made this difficult decision.


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## GoodandPlenty (Feb 4, 2012)

*Final Update:*

A large lump was discovered under Sophie's shoulder on 15 September.

An exam was conducted and a biopsy taken on 17 September.

Cancer, "soft tissue sarcoma" was confirmed on 24 September. Because of the sudden onset and immediate large size this was the expected result.

Due to the nature of this particular tumor, it was considered inoperable without follow-up radiation treatments. Most of the mass could have been removed (major surgery with considerable risks). Although slow to metastasize (spread to other areas of the body), it is locally aggressive and spreads in 'tentacles', making complete removal extremely unrealistic and radiation follow-up a requirement.

I decided to make the most of what good time she could still have - up to but not including a massive and unwarranted medical intervention. Best guess was 4 to 8 weeks. We got about 3 1/2 weeks.

At no time did Sophie seem to be in any pain or discomfort. A 'tumor exam' was added as a daily routine; between 'together time' and being returned to her cage. Each day I petted the tumor, 'sized' it between thumb and forefinger, and palpated it a bit (gentle pressing to test for sensitivity).

She had full range of motion in her leg and her running remained within norms the entire time. The tumor did grown 'high and tight' under her jowl, but this did not impeded eating, which was confirmed with the continued hand feeding of two or three pinky mice every day. She may have favored chewing on the non-cancerous side of her mouth, but showed no signs of discomfort or inability. She chowed down the pinky mice just as quick as ever. She continued to vacuum up mealworms that were put out late-night.

When the tumor first presented itself, consumption of her main food blend crashed from ~24 grams per night to ~6 grams per night. Her appetite recovered and consumption increased to ~12 grams per night.

This ~12 grams per night should not necessarily be considered an extreme drop in consumption from her original level, however, because her food blend was changed to a high-protein, high-fat, high-nutrient blend. Previous to the tumor, her blend was diluted with 'filler' - baby food vegetables were used in her food blend in order to keep her from gaining too much weight. In the end, caloric intake was likely equal to her pre-tumor total. Her weight was mostly stable; one week of highish loss; one week of highish gain; and modestly up or down the remaining weeks.

However, there came a point where we were not feeding the body, but feeding the cancer. The cancer was stealing away the nutrients and though her weight was mostly stable, her body was losing weight to the tumor, which was growing and gaining weight.

Originally, we had planned to use weight loss as a guide to decide when euthanasia would be most appropriate. When she began to lose weight at a pace that I could not control, it would be time.

Because the tumor was stealing some percentage of her nutrients, we decided it would be necessary to go by two other standards. First, 'pep', or quality of life. Was she still running decently? Was she still enjoying mini-baths, petting sessions, and belly rubs? Was she still enjoying nap time, running way up my shirt and snuggling in tight? Second, did she appear or feel thinner in the body or belly?

At no time did Sophie ever show sensitivity or any sign of pain. She never showed any indication that she was sick at all - ever. (At least once consumption of her primary food blend picked back up.)

I knew that her body was somewhat thinner, and I knew that she was a bit thinner in the belly, but it didn't seem major. I knew that the tumor was continuing to grow, but gave more consideration to the continuing 'firming up' of the tumor than to an increase in size.

*However* - despite daily tumor inspections, the growth is so incremental that it is very difficult to assess changes. I got video of most of the tumor inspections. It wasn't hard to setup, and was easy to do as a daily thing. Most of those videos are 4 to 6 minutes long (and I really only needed like 2 minutes).

Out of curiosity, I compared a later video of a tumor inspection with an early video of a tumor inspection - *and was shocked at the amount of growth.* Though monitoring every single day, it is just so hard to notice a slow and steady change. But the videos made it very clear that the tumor was doing a lot more than becoming 'firmer'. *It was also growing quite a lot more than I had any idea of - despite daily monitoring for exactly that.*

scruff-metacam-b-14-09-18
(3:40)





tumor-inspection-14-09-29
(3:52)





tumor-inspection-l-14-10-18
(3:47)





*This immediately caused me serious worry that I was possibly seriously underestimating the loss of body mass and potential deterioration to vital organs.* Yes, she was eating well - but we were feeding the cancer, not the body.

*I immediately ruled out waiting for a loss of 'pep' *and scheduled her euthanasia on Friday for a Monday appointment, which gave us one last weekend. I had always intended (if possible), "Better two weeks too soon than one day too late."

The euthanasia was handled perfectly by the hospital staff. It was a good death. (A video of the procedure would be both instructive and comforting for people, but for any of several obvious reasons you will understand why it was not a priority.)



> *From an email sent to my mother about the euthanasia process, which included some pictures taken Sunday night (which I rarely took night pictures; this was an exception):
> *
> It's done. She did okay on the drive, as usual. Stuck her head out and sniffed around a bit. Less than usual, maybe, but arrived in pretty good shape.
> 
> ...


 &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
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A video of the body, ready for burial, as released from the hospital. For obvious reasons, a one-take video. Not easy to watch. I wouldn't recommend it for most people, but this is a part of what you deal with - the closing of the circle of life for Sophie. This worked fine for us, but cremation was an option and might be easier for a lot of people; the additional cost well worthwhile. For some, a burial might be a healthy ritual. For others, it might be another heavy weight on the emotional scale.

euthanasia-14-10-20
(9:57)




&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.

I highly recommend the book, _"Blue Juice: Euthanasia in veterinary medicine."_ (Morris, Patricia) (Temple University Press, 2012) (about 190 pages of text and 35 pages of source citations and index.) (Part of the Animals, Culture, and Society series.)

Blue Juice is probably intended more as a professional resource than a mainstream text. However, the writing is excellent and accessible to the non-professional.

I would like to have seen another 75 pages or so given over to more detail case study of emotional toll from the viewpoint of owners. The text is strong on addressing the issues for the professional, but even as a target audience, this group would benefit from a much more detailed overview from the perspectives of owners and emotional toll. I found this oversight to be significant.

Though the veterinary professional has many daily concerns about where, when, and how lines between life and death are drawn - owners have to live with the same or similar concerns every day. Though the market for this book is probably the veterinary professional, not owners, they would benefit a having a greater understanding of what it's like on the other side.

Blue Juice is an excellent book and I recommend it highly, but the failure to include owner perspectives about where, when, and how lines between life and death are drawn leaves out considerations that the professional needs to be aware of and account for.

I would rate my education, life experience, hedgehog knowledge, and understanding the needs of the animal as well above average. Though well prepared emotionally, the day by day buildup of stress was greater than I had allowed for. Also, despite a high level of awareness and preparedness, making the judgment of 'when' was far more difficult than expected. As a resource for the veterinary professional, the omission of emotional considerations and the building levels of stress for owners is glaring.

Many mentions are made of owners that would put down an animal all too easily. To essentially omit the emotional toll of the 'best guess' made by owners that want to make the best decisions at the best times . . . that was disappointing. Perhaps a second read will adjust my perspective, but my first read was extremely thorough.
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.

So, after 2 years and 9 months of much love, goodbye Sophie.

.


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## DesireeM81 (Jun 14, 2014)

Definitely the hardest post of yours to read. I am sorry about the loss of your Sophie but you and I and, I hope, others will take some comfort in knowing that she was laid to rest in the most humane and loving way possible and that she never once had to suffer. 

Your posts were always informative and there was a tender way in which you spoke about Sophie and that the love you had for her was apparent. 

I want to say thank you to you and Sophie for sharing your experiences. It is hard to watch and hard to read, but in some ways absolutely necessary.

RIP Sophie.


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## CoffeeKat (Jan 15, 2014)

I cannot say anything better than what Desiree has said. Major respect to you, David, for the way in which you have handled this situation. Please don't stay away from this community. Thank you for sharing this wrenching experience with us, and hopefully it has been cathartic for you as well.


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## gracefulchaos01 (Mar 19, 2014)

I was thinking about Sophie earlier this week, before my Panama had his issues. I was hoping she was doing as ok as she could be. I'm glad to read that she was. All the way to wherever all of us go when we pass from this life. 
I know this entire experience must be difficult. Thank you so very much for including us in Sophies oddessey all the way to the gentle and loving end.


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## MomLady (Aug 14, 2010)

My heart is breaking for you and Sophie. Thank you for all your contributions to HHC and I hope you will remain a contributor here.

We need more people like you here.

Thank you for sharing with us the details. We know we will all have to face this and going in informed will help us help our hedgies.

Hugs and heartfelt sympathy. 
ML


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## Nancy (Aug 22, 2008)

I am so sorry. Sophie was a wonderful little girl who left this earth way too young. Hugs


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