# Lump on mandible



## larissa (May 21, 2014)

I noticed a small lump on the left side of Pearl's lower jaw on Friday, March 6th. Couldn't get in to the vet until that Monday evening. She said it didn't look or feel like a tumour but she couldn't rule that out. She gave a 3 week course of antibiotics to start, to be given twice a day. Pearl didn't like it and was very fussy with the syringe, so I tried making "medical meatballs" by injecting it into a bit of pate and that worked much better. She tolerated that for just over a week, then last Tuesday refused to take her morning dose. She also seemed a little weak so in a panic I called the vet and they saw me later that day. That was a different vet, and he said he thought it wasn't an infection but was probably cancer and suggested the humane thing to do would be to put her to sleep right then! I said no, because the only change in behaviour I had noticed was just that morning, and she had even eaten some worms after I made the vet appointment that day. So he gave metacam to give in addition to the antibiotic, saying it might just make her more comfortable.

So now we're 6 days later and she's been taking both her Metacam and antibiotic like a champ, and otherwise acting basically completely normally. She's eating, drinking, running in her wheel, playing with me when I have her out for our bonding time. She really seems like herself, except for this growth on the side of her mandible. I know they hide it well but she doesn't seem to be in pain, and will only sometimes kind of paw at the growth, not scratching but more like she's trying to flick it off of her. I was given only a week's supply of Metacam then they wanted to reassess so I have to call them back tomorrow. I know oral cancers are very common in hedgies, and I also know that perhaps she's behaving so normally might be due to the pain relief/anti-inflammatory properties of the metacam. I'm wondering if I should push for a biopsy, though. I was a little annoyed it wasn't even offered in the first place but was willing to try the drugs recommended. However, Pearl did have a growth in her abdomen last year that they guessed was a uterine tumour, so they spayed her and tested the growth and it wasn't cancerous, it was just a benign cyst. So I'm now wondering if it's possible the growth on her mandible is also benign. I know the odds, but I'd also just like to know. And if it is benign, if it would be possible to remove it. 

Has anyone had pushback from a vet about a biopsy? I have to say I was really unimpressed with the last vet I saw (I'd never seen him before; Pearl goes to a clinic with several vets on staff who specialize in exotics, and she's only seen 2 different vets there before - this guy was new to us). I'm hoping our next follow-up will be with a different vet! Just wondering if anyone has any thoughts or advice.

-Larissa


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## Ria (Aug 30, 2018)

If you do get a new vet or even the same one, I would ask about it, and if they try putting it off I would ask why. Because if there is a reason they dont want to, you need to know. You have the right to know because it concerns you and your pet.
If it is cancer, its better to get it now while its early so you have less chance of it spreading. Plus she is still normal and seems to be strong it would be better to have removed while she is strong and not weak.

I really hope this helps, and that you can get somewhere with this.


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## larissa (May 21, 2014)

Thanks for that encouragement. We have an appointment this evening and will be seeing the same vet who originally saw Pearl 2 weeks ago (not the one from last week). Due to restrictions around Covid-19, no humans are allowed to enter the vet clinic now, so everyone has to hand over their pets at the door  So I've typed up a list of comments and questions for the vet that I'll hand over with Pearl, and gave them my cell number so the vet can call me before/during the exam as I wait in the parking lot... I included all relevant information that I could think of, and asked about a biopsy and possible treatment options for if the lump is cancerous vs. benign. Fingers crossed...


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## Ria (Aug 30, 2018)

Good idea, I hope you get some answers for what it is and treatment to help!


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## larissa (May 21, 2014)

So the vet visit went well, I think. The vet called and spoke to me while I waited in the parking lot. She said if I wanted to go the biopsy route she'd suggest just scheduling a surgery to remove the lump and then send it off for analysis. So she didn't biopsy anything yesterday but did give me some more Metacam, enough that I won't have to come back for reassessment for a while - and enough that I won't need more for post-op recovery should I choose surgery. I'm waiting to see how Pearl is throughout today, but if she's still basically behaving as normal, I think I will call and schedule that surgery tomorrow. I don't take putting her through surgery lightly, and I know that if it is cancerous then it will just return later. But if it's benign, then this surgery may be enough to simply deal with the issue entirely. Pearl is a tough little cookie and has always done well with both sedation and her one other surgical experience, so I'm hopeful that trend will continue.


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## Ria (Aug 30, 2018)

If she still seems strong, I would go with surgery. Whilst it could be benign and nothing really big to worry about, that would be great and at least she won't be living with a lump on her face! 

At least if it is cancerous, you will have removed it early, so its not had much chance to spread which is great! Plus she she is stronger for pulling through the surgery! Another great positive.

Its up to you, but if you think its a good idea, and you think she is up for it, I would say go for the surgery.


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## larissa (May 21, 2014)

I called and booked Pearl's surgery. Unfortunately it's one full week away - the clinic is temporarily short-staffed in terms of surgeons, as one is in self-isolation after being in Mexico recently. So although I requested my preferred vet to do the surgery, they told me we don't really get much choice right now with the way things are. And lo and behold, Pearl's surgeon is... the vet who suggested I put her down last week! I'm sure he's a competent veterinary surgeon and I don't want to question his qualifications, but I'm uncomfortable knowing that he's going to be operating on an animal he has previously recommended euthanizing. However, if I call the clinic to reschedule, that will mean waiting even longer for the surgery, leaving more time for Pearl's lump to grow...


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## Ria (Aug 30, 2018)

Try not to worry, I don't think he would kill your hog while in surgery. It was a stupid suggestion but I don't think any vet can kill an animal on purpose during surgery. 

Watch the activity and health of your hog, and try to make sure she stays fit and strong for the surgery.


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## larissa (May 21, 2014)

So Pearl's surgery is Wednesday, and over the weekend she started to seem irritated by the lump. It's continued to grow and it's getting in the way of eating properly - things get very messy and she seems annoyed. So I started feeding her baby food that is very thick liquid and she loves it, and a bonus is it is easier to mix her meds in with that! But she's started pawing at the lump - not scratching, but kind of like she's trying to flick it off of her jaw. So it's now looking kind of raw and pinkish/reddish - no blood or broken skin, but it doesn't look happy. I clean it a few times a day gently with a baby wipe and she doesn't mind that, but I'm wondering if there's anything else I can do for her in the 2 days left before her surgery to make her more comfortable. Other than this, she's still herself, climbing and crawling around when I have her out for bonding time, and she still has a healthy appetite. I just wish it wasn't such a long wait for the surgery.


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## Ria (Aug 30, 2018)

If you have some sort of anti bacterial cream do a test with it rubbed in your finger and see how she reacts to it, if she doesn't react badly put it on the lump, it might help sooth it a bit.


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## Kalandra (Aug 25, 2008)

If it is just irritated and not an open wound, I'd just keep it clean and continue to feed her a soft food diet for now. You are almost there. if the situation changes, for example she digs at it and breaks it open contact your vet immediately. They may be able to fit her into their schedule sooner for an open wound.


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## larissa (May 21, 2014)

No broken skin yet that I can see. I'm just hoping to keep her as comfortable as possible until I drop her off at the clinic tomorrow morning. I'm well aware of the risks and possibilities but was confident in my decision to pursue surgery up until today. I still think it's the right thing to do but am feeling nervous for the first time. The lump has grown in the past 3 1/2 weeks which makes me nervous, and she's now been on antibiotics for 3 weeks and Metacam for 2 weeks which would put anyone through the ringer a bit. But I've trusted Pearl to let me know what she wants, and she still seems like she just wants that thing off her jaw, so that's what I'm doing. She's still bright and curious when she's out of her cage, and has a very healthy appetite - especially now that I added baby food into her diet along with pate and worms. And she still goes for kibble, though less so - but that's probably due to the lump getting in the way. Fingers crossed all goes well tomorrow - I just wish the surgery was with a different vet, that I could trust.


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## Kalandra (Aug 25, 2008)

How did Pearl's surgery go? How is she recovering? Been thinking about you and hoping for an update. 



I know how you feel about not using a vet you don't want to, but at least we still have vets willing to help our little ones. I know a couple of folks who had their vets basically take the approach of they don't have to expose themselves and won't. Really makes me wonder if they were just in it for the money or if they really cared for the animals...(sorry to sidetrack, frustrations of trying to help a couple of hedgehogs who really need the help). Anyway... not to side track, how is Pearl? How are you holding up? Any virtual support we can help you with?


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## larissa (May 21, 2014)

Thanks for asking! 

The vet called after Pearl was sedated but before starting surgery, he said to outline what he saw and confirm what I wanted. The growth had grown inside her mouth (which I can never see because she refuses to let me look inside!) and had involved 3 teeth. He said he thought it was still limited to the gums, not bone, and the teeth weren't impacted or inflamed yet. But due to the size of the growth and its location, to remove it fully would require major reconstruction (not enough healthy tissue to stretch over the wound, so sheep skin would need to be grafted on). He said he would still do it if I wanted, but that it would be a major surgery "even for a dog or cat" (which annoyed me a little as it seemed to imply a hierarchy of animals) and that her recovery would be hard. Given her age and her condition I elected not to have the surgery done, and simply asked to take her home and just take it day by day. I did ask if we would be able to get in to the clinic very quickly if she took a turn for the worse and he said that yes, arrangements for that kind of appointment can be made at any time.

So she's been home for the past week, with a new batch of antibiotic and Metacam. She is still being her sassy little self, with some adjustments to her environment. I removed her shavings and her kibble, to prevent any hard scratchy surfaces from potentially causing her harm. I am using a saucer as her food dish now so she doesn't have to lean into a bowl. She is a big fan of pureed chicken in broth baby food, even with her meds mixed in, and still asks for worms daily - but I now crush them so they're in very small bits and easier for her to eat. Her appetite and energy is very high and she is still running in her wheel up to 3 hours a night, and often flips her saucer over in the middle of the night to ask for more food 

Since I'm working from home now, I'm able to check in on her very frequently through the day, and am spending lots of time with her in the evenings, and have even started sleeping in "her room" so I can listen for anything untoward in the night. I take care to inspect and "clean" her lump and mouth (with a baby wipe) every day, and am always watching for any signs of discomfort or unhappiness. I know our time together is limited, but we're spending that time with lots of food, lots of cuddles, and lots of activity (she still loves climbing up my arms and on my shoulders when she's out for bonding time). She's a special little lady and I feel so privileged to be able to spend this time with her.


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## Kalandra (Aug 25, 2008)

Not the update we wanted, but I would have opted for the same. Sometimes its better to do nothing but spoil them rotten. Anything she wants right? Take it day by day and I guess one good thing about these stay at home orders is we can sneak time in during the day to take care of our little quilled patients.


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## larissa (May 21, 2014)

Oh, I forgot to add: I still haven't gotten the biopsy I wanted, obviously, as no surgery took place. The vet said in his opinion there is no doubt that it's cancer given how it looks and how it's growing. He did listen to my concerns about how I was never able to get a firm diagnosis, and how all I wanted from the very first vet visit was for the still-small (at the time) lump to be tested and possibly removed while it was tiny and it would therefore be a minor surgery, just to give Pearl more time to be comfortable. I noted that had I brought in a dog with a small lump, there would have been a scan or biopsy right away, and that just because cancer is very common in hedgies doesn't mean lumps and bumps are all always cancerous, and an early diagnosis can't do any harm anyway. To his credit, he did listen and seem to take my point.


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## barongan (Aug 6, 2018)

Ria said:


> Good idea, I hope you get some answers for what it is and treatment to help!


+1.


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## Ria (Aug 30, 2018)

Well I think opting out of this one was a good choice. Not great news though. Enjoy all the time you get left and spoil her rotten!
Some vets are like that, and need to be pushed to actually get what you want with hogs! So annoying when you know if it was any other animal your not likely to need to push them for what you want.


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## HedgieloveHershey (Apr 15, 2020)

Please let me know how she's doing!!! We're all here for you


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## larissa (May 21, 2014)

Thanks for your concern 

Pearl is still doing her thing, but the lump has continued to grow and is slowly becoming unsightly. No broken skin or anything, just a large ugly lump. Because it's on her lower jaw, it kind of hangs down a bit, so I've continued to modify her eating arrangements. I've removed her food bowls and dishes and am using a flat, thin but sturdy small dish so there is no lip that can scratch the lump, nor does she have to reach over anything to access food. Since I don't have kibble out anymore, I feed her frequently, mainly at night. We've developed a system where I feed her meds and baby food just after 8pm when she gets up for the night, and I crush freeze-dried insects for her and she LOVES that. I clean her up with a baby wipe and we hang out for a bit. She then alternates between naps and running like mad in her wheel for a few hours, and I feed her more baby food before I go to bed, then leave out a bit of crushed dried insects for her to snack on over the following few hours. She then wakes me up usually between 3-4am for more baby food! I do a feeding and clean her up and again leave out more crushed insects for her to snack on at her leisure. During the day I do one baby food feeding with meds, but otherwise she's mostly sleeping, though I leave out crushed insects and she usually comes out to snack on them at some point. She's still running in her wheel for a few hours each night, so she's still quite active and I assume feeling okay despite everything.

Since I sleep in her room, I'm getting way less sleep these days! But I don't mind, as long as she's comfortable and well-fed. And although her wheel activity keeps me up too, I still like hearing those reassuring little noises through the night because I know she's doing all right, at least for now. Pearl has clearly surpassed all expectations of both vets that have seen her in the past month and a half, and I'm proud of my little lady, and just happy to have this time with her.


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## HedgieloveHershey (Apr 15, 2020)

Oh that's a great idea! Please let us know how Pearl does


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## Kalandra (Aug 25, 2008)

I was hoping you had posted an update and am happy to have found it. It sounds like she is still doing pretty well considering and that she is being treated like the little princess she deserves to be. Those tumors can get quite large and unsightly and yet they will deal with it and continue on for a while.


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## larissa (May 21, 2014)

So just now when Pearl came out for snacks and bonding time, I noticed there were some dried spots of blood in her cage. I thought maybe something had scratched her lump but while big and ugly it didn't look much different, or bloody. Then I noticed she seems to have a cut on the other side of her face, on her cheek. There's a small line of dried blood there, maybe a few millimeters long. It's not actively bleeding, and I couldn't see or feel a new lump, so I figure she must have scratched it somehow - but I can't figure out how. Of course, I still haven't been able to look inside her mouth - she's never let me do that! - so I know there could easily be something very wrong with some teeth due to the lump, for example.

At any rate, I gave her a little foot bath because she had some dried poop stuck to some toes, and she was behaving just as she always does; afterwards she crawled on me as usual, sniffing things out, until I put her back in her cage. Despite her normal behaviour and still-healthy appetite, I'm obviously more worried now with the appearance of blood. I've changed all of her bedding and pee pads, and gave her her antibiotics and Metacam with baby food, and now she's gone off to hide for a bit (as usual after bonding time). I'll be paying close attention to her all night tonight and through the day tomorrow, since the vet is not open until Monday.


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## larissa (May 21, 2014)

Minor update: after watching her like a hawk over the weekend, I can see the mark on her cheek must have been smeared from elsewhere and isn't an injury site itself, and there has been no new blood stains anywhere in her cage. She must have scratched her lump at one point and that caused the bleeding, and she just got some on her other cheek. She's been very active the past 2 nights and still has a healthy appetite, so I'm relieved. But still monitoring her ever-growing lump for signs of injury. I suppose it's a good thing, in a way, that she's been on antibiotics for almost 2 months now :/


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## Ria (Aug 30, 2018)

I'm glad the blood wasnt any real big issue, thats the last thing you want!
In a way it probably is a good thing she's been on the anti biotics for so long.
I'm glad she is still seeming herself too!


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## Kalandra (Aug 25, 2008)

I'm wondering if a tooth came out. Could cause a little bleeding and be undetectable even if you could look in her mouth. I'd say poor quilled kid, but I'm sure she continued on like nothing has happened wondering why mom is stressing out.


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## larissa (May 21, 2014)

Ah, that's a good point. I struggle to examine the inside of Pearl's mouth because she just never likes me to do that, haha. I have to steal quick peeks when she's crawling on me. But I know that her lump is not just on the outside of her jaw so a tooth loss is a very real possibility. All of this worries me, because I can't imagine carrying on like normal with all of those things impacting me! Yet she just soldiers on, doing what she's always done. The only difference I've noticed behaviour-wise is she's sleeping a bit more - she used to get up to snack during the early afternoon and now she tends to come out only closer to the evening. But she was still up and running in her wheel for a couple of hours last night, and although we've had to switch to a nearly entirely pureed diet due to the lump, she still slurps up her food and asks for worms. I'm amazed at how resilient she seems to be. I just hope she's not suffering in silence, though she's giving zero indication that that's the case!


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## Kalandra (Aug 25, 2008)

One of the things that has always amazed me over the years in caring for cancer patients is their will to keep going. Hedgehogs do an amazing job of continuing on normally if they can. 

Sounds like she still has a good appetite, how is her weight holding?


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## larissa (May 21, 2014)

She was 410g yesterday, which is at the low end of her normal (she tends to be between 410-415 pretty consistently, except for about a month ago when I focused on pate as we moved away from kibble as her tumour developed - she shot up to 430g within one week at that point! But then her weight came back down to the low teens as I backed off the pate and fed a mix of that plus pureed baby food). So, still normal.

Today I had the unexpected pleasure of calling the vet for a refill of Metacam, because we have only a few doses left. When the vet gave it to me a month ago she seemed confident it would "last a lifetime" - but Pearl is outlasting all predictions. Still waiting to hear back from the vet about whether or not I can just pick up the refill or if she wants to examine Pearl again, which I really hope isn't the case - I don't want to put her through the stress of travel plus possibly sedation at this point in her life. Fingers crossed...


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## larissa (May 21, 2014)

What a difference 10 days makes... 

I just made a heartbreaking call to the vet clinic. We have an appointment tomorrow afternoon, for what will likely be Pearl's last vet appointment. In the past 2 days her activity level and mood has taken a sharp turn; she stopped running in her wheel and has barely eaten anything, though is still drinking a bit. I started syringe feeding her yesterday, but she's even fussy about that - for the first time in her life, she has no appetite. She's spent most of the past 2 days and nights sleeping, and seems weak. 

I know it's time. I promised her I would spoil her rotten as long as she was happy and comfortable and doing the things she enjoys; there's been not much enjoyment for the past few days, and while she's not completely miserable, I don't want her to get to that point. I know the end is near-ish at this point. 

Making the appointment felt awful, but I know it's the right thing to do. I trusted her to tell me when she was ready, and looking into her eyes now I know this isn't the life she's happily lived for the past 6+ years. My Pearl is still there, and still has some of her usual sass, but she's not living a good life anymore, it pains me to say. I feel bad because Pearl doesn't like the vet clinic, and being in a brightly-lit, cool, noisy place is the least ideal situation for a hedgie already under stress and feeling ill, and I hate that I'll be putting her in that situation. But the alternative of slowly wasting away is worse. I'm glad that despite Covid restrictions, the clinic allows 2 people to be present for final visits, and that their procedure for hogs is modified (usually sedation is done in the back where people are not allowed, but in this case I'll be with her for the sedation). Small mercies.

Thanks everyone for your input, suggestions, and support these past few months. Cancer sucks, and the fact that so many hogs fall victim to it is so sad. Pearl and I were lucky in the sense that she's already an older lady and exceeded all expectations after her diagnosis; the vets originally gave her a few weeks, and it's now been 2 and a half months. Doesn't make it any easier though!


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## Kalandra (Aug 25, 2008)

Cancer does indeed suck. Even when you know its the right answer, it never feels right. It always sucks and it hurts. At least you have had a chance to spoil her rotten the fast few weeks, gotten to spend as much time as you could with her. It never feels like enough, focus on the happy memories. Hold her, tell her you love her and try to enjoy some cuddles with her tonight.


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## larissa (May 21, 2014)

*Farewell, little one*

Well, my little lady is gone. Thankfully, we got one of the good vets (one she's seen before and who has some knowledge of hedgehogs) and a very kind vet tech. They ushered us in the back door so we could avoid the waiting room, and they had set up a small zen water feature in the room. They gave us all the time we wanted to hang out with Pearl before getting started, then when we were ready they gave her a muscle relaxant to make her drowsy. The vet tech was surprised she didn't even flinch when she got the injection; I said she's always been a little trooper and a tough cookie, and she still is! They then let us sit with her while she got super drowsy, and we let them know when we were ready for the rest. The final part took all of 2 minutes, if that. Her little body was so weak but her spirit was so strong right to the end. Now her room is empty and I'm heartbroken, yet I don't regret anything and I know she was ready. Tonight will be a sad one, since I've spent every night beside her cage for the past 2 and a half months. I've lost many animals in my life and it never, ever gets easier.


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