Ear lump revealed to be possibly malignant melanoma

Discussion in 'Health & Wellness' started by Liung, Nov 29, 2018.

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  1. Nov 29, 2018 #1

    Liung

    Liung

    Liung

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    I’m crying so hard right now, the vet just called me about Lahi’s cytology: melanoma with results that indicate it could be malignant.

    He’s had this small warty lump on the base of his ear for years now, but it didn’t do anything and so we didn’t worry about it. Mid-year this year, however, it suddenly tripled in size and started threatening to break open. I was in the middle of moving cities, my old vet gave me some antibiotics to see if any reduction could happen, and some antiseptic wash to keep it clean. It looked like it stabilized, but when it started getting angry looking again I booked an appointment with the OVC.

    That was a couple weeks ago. They quoted me for bloodwork, biopsy, and histopathology: $800. I agreed, and did the bloodwork. After some confusing results the first time, the second sample came back completely healthy, so I asked to book the surgery. But then they said they wanted to do a fine-needle aspiration first, to check for malignancy. No sense doing the surgery, then finding out it was locally invasive and having to do a second.

    And, because of its location on the base of his ear, to take more would be to remove his entire ear. Oh dear!

    I nearly didn’t, because again: he’s had this thing for years and it only just started causing problems. It’s black and bumpy, while the rest of his skin is white. And you can feel that it’s moveable, attached only to his skin, not to the cartilage. So it’s probably nothing, right? Just like a mole!

    But then it occurred to me if the cytology results came back to say it was just a benign growth, they could take smaller margins and he’d definitely appreciate having less of his ear cut off. So I said okay, $180, fine needle aspiration, go for it.

    Well, just got the call. I was right it’s a melanoma, but with results suggesting it’s malignant, apparently malignant melanomas in rabbits are often metastatic?? So now they don’t want to do the surgery at all until they’ve done screening to see if it’s spread to his chest and organs. $765 for a full body CT, or $86 for an ultrasound and $116 for a chest radiograph. This on top of the $800 for removal and $180 for the cytology.

    I’m working just under full-time at a minimum wage job, so I can actually afford the radiographs, barely, by relying on my hubby to cover all our living expenses. But Lahi is 12 years old this January, so on the one hand, should I be bowing to the encroaching inevitable? But on the other hand, he is so happy and healthy, I was fully expecting many more years with him.

    I will have to do the radiographs, because pretty much the moment he’s recovered from this surgery he’ll have to do another for his annual tooth trim, so we need to know if his organs are compromised.

    But oh my god, I thought this was going to be just a quick removal of a lump that was getting uppity and now it’s spiraled down into my worst nightmares. My baby boy... I still hadn’t gotten over the idea that he might have to lose his entire ear, and now this?

    IMG_0688.jpg

    Better yet, there is absolutely no pet insurance in Canada that helps with rabbits. This is all right out of my pocket with no recourse.
     
  2. Nov 29, 2018 #2

    Popsicles

    Popsicles

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    I’m so sorry to hear that, what sad news :( I really hope the radiographs come back clear. Malignant melanoma is pretty rare in rabbits, so although they have been recognised to be “often metastatic” that is based on a very small sample size - the true answer is we just don’t know that much about how malignant melanoma behaves in rabbits. I have all my fingers and toes crossed for you that Lahi is one of the lucky ones.
     
  3. Nov 30, 2018 #3

    Liung

    Liung

    Liung

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    The vet said she still had to go consult with surgery on what they think is best, but it’s definitely looking like if we go forward with the surgery that they’ll want to take the entire pinna to be safe. It’s such a blow, we had a “terminal” diagnosis in 2014 where treatment was supposed to require removing his eye, and he breezed through that with a noninvasive antibiotic treatment. Then last year Delilah gave me a heart attack by developing a tumour and results came back, completely benign trichoblastoma. And it’s been almost 5 years of him having the lump and showing it to every new vet and none of them expressing any kind of concern over it, mystified but unworried. So I went into this about as optimistic as someone can get when it comes to mysteriously growing lumps... bloodwork came back completely clean, everyone at the hospital can’t stop exclaiming about how healthy he is for a 12 year old, he’s been bouncing around so energetically, I’ve been happily waiting to hear that it’s no big deal, we’ll remove it right away...

    “I have the results back from Lahi’s cytology. I’m sorry, it’s not good news.”
     
  4. Nov 30, 2018 #4

    cwebster

    cwebster

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    Am so sorry to hear about Lahi. I just had to haveour old guinea pig, Chubby, euthanized during surgery to remove a lump due to metastatic cancer of all his organs so i know how hard things can be. If Lahi seems happy i might just keep him as happy as possible for as long as you can. Or maybe work out a payment plan and get the xray. I hope Lahi’s melanoma hasnt spread and that he does well. I will hope for the best for both of you.
     
  5. Nov 30, 2018 #5

    Liung

    Liung

    Liung

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    So I know that I’m still probably in the denial stage of grief and that’s probably influencing a lot of my thinking but...

    The lump is the start, no question. It appeared in 2014 and for the past four years has done absolutely nothing. So I’m basically sure that it’s the parent tumor. If there was an internal parent tumor, and the ear lump was a child tumor, then the parent tumor would have had to have been metastasizing this entire time and that clearly hasn’t happened.

    So I feel right off the bat it’s safe to assume that the ear lump is the parent tumor. Okay.

    So now there are two outcomes here: it’s already started to spread, or it hasn’t. If it hasn’t, removal ASAP is the best thing that could possibly be done. If it has...

    I’m not as clear on the behavior of child tumors but I think they don’t then become parents themselves for at least a while? The metastatic parent tumor is the primary source of tumors. So if the ear melanoma has become metastatic, removing it will still improve his prognosis. I doubt I’d want to try chemo/radiation, but that’s the usual course for human cancer. Remove the main tumor and then blast the little ones.

    As I said I’ll likely need to get the radiographs anyway because he’s due for his dental trim soon... but the OVC has quite the wait time, usually. The vet called me today and even though we’re obviously on crunch time and need to get this solved ASAP, they couldn’t fit me into radiographs until next Tuesday, just under a week away. This despite the fact that when I saw her for the cytology, she said “oh, did it get bigger?” As compared to the last time she saw it a week prior.

    Would it make more sense to say “**** it, remove it now and fingers crossed it’s not spread yet”?

    The concern the vet had was that if it’s spread to his liver, he won’t survive the surgery to remove it. Bloodwork came back with normal organ values but the liver function has to be 70% lost before anything will show up on bloodwork.

    And that is a concern, but I almost feel like... he NEEDS this surgery. If he does not have the surgery, this melanoma will almost certainly kill him. So if he doesn’t survive the surgery... he’d be under anaesthetic, he wouldn’t be in pain, and if we do the radiographs first and find out he can’t have surgery, euthanasia would be the next step anyway; it would just be a matter of at what point would he be in too much suffering and pain to keep going? How much longer would he have before I had to say goodbye?

    More than anything else I do not want my little boy to suffer. Right now he is happy and healthy and bouncing around but now I know this is only temporary. Surgery or euthanasia, those are apparently the only outcomes here, and I refuse to be one of those people who keeps going long past the point that the animal has any enjoyment left in life, just because they can’t say goodbye.

    And that sounds so cold and heartless but I am sobbing so hard right now I can’t even really see the screen. My literal actual job is to assess the health of animals for signs of pain and suffering, give emergency treatment as necessary, bring burgeoning problems to the attention of the vet, and in the worst cases, make the call that the animal is in so much pain and suffering that they can’t wait for the vet and euthanize them myself.

    So having seen that, having lived that, being literally trained in recognizing that an animal is suffering so much that euthanasia is the only ethical choice...

    I don’t want that for Lahi. I find the idea of him deteriorating and suffering and in pain even worse than the idea of losing him. Everything about this sucks and I have no idea what to do but I can’t help but think that he should be booked for the surgery tomorrow if I can manage it, and if he doesn’t make it then at least he goes before he is ever in pain.

    Am I being irrational? I know I’m being emotional but is there at least some logic in my desperate hope that we can get through this and have everything be okay?

    He’s been through SO MUCH without ever skipping a beat, springing health problem upon health problem on me like he was filling out a bingo card, it feels phenomenally unfair that what’s finally getting him is a tiny lump that we’ve known about for ages, with nobody worried about it in the slightest.
     
  6. Nov 30, 2018 #6

    Popsicles

    Popsicles

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    I totally feel for you - I know you look after your buns so well and are great at recognising health issues, so you have really been dealt a rough hand :(
    I can see the appeal in removing it ASAP, and I would certainly be tempted in your position. Alternatively, he’s had it so long, that I would imagine another week or so won’t make a huge difference to his prognosis, as by this point it has either metastasised or it hasn’t. You wouldn’t want to put him through that surgery and recovery, especially as he is well in himself at the moment, only to find it won’t help anyway. There isn’t much you can do for lung metastasis, even chemotherapy isn’t particularly helpful, so at this point I don’t think it will make much difference. I can certainly see both sides of the argument, and I think it’s best to do whatever your gut tells you - neither one is the “right” decision, so whichever feels best to you will make you feel better in the long term as you know you did everything you could have. I hope that makes sense, and if you need anything at all just ask, I’m here.
     
  7. Nov 30, 2018 #7

    Bam Bam

    Bam Bam

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    I am so sorry for everything you and Lahr and don’t think there is any words or advice that would make things better.
    You are a terrific amazing bunny patent and Lahi is so lucky to have you.
    My thoughts and prayers for you and please keep us informed.
     
  8. Dec 1, 2018 #8

    Liung

    Liung

    Liung

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    In case anyone is curious as to the exact nitty gritty of Lahi’s cytology results. Personally I have just enough of an education to recognize most of the words of the tumor analysis, though not enough to really understand the significance.

    IMG_0835.jpg
     
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  9. Dec 4, 2018 #9

    Liung

    Liung

    Liung

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    Lahi had the radiographs and ultrasound today, the vet just called with the results: NO MASSES FOUND!!

    She started to go on about some kind of mineral buildup they found in his lungs, osteo-something or another, honestly I heard “no masses found” and couldn’t bring myself to pay proper attention to whatever this mineral buildup is after she said it was benign and wouldn’t be an issue. NOT GONNA WORRY ABOUT IT RIGHT NOW. Busy crying my eyes out from relief.

    So they’re gonna do an echocardiogram this Friday to check out the heart murmur. The tumour removal is currently scheduled for next Thursday, though they’re going to try to move it up sooner than that. There’s a small chance that they won’t be removing his entire ear, but at this point I’d rather they did if that means a greater chance of getting it all.

    Seriously sobbing from how overwhelmed I am right now, please please let us have caught this in time. I’m almost afraid to fully believe that he’s going to be okay.
     
  10. Dec 4, 2018 #10

    Popsicles

    Popsicles

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    I’m so so pleased to hear that, what fantastic news! I would agree with you better to remove more than less and then not have to worry about it anymore. Great great news!
     
  11. Dec 5, 2018 #11

    cwebster

    cwebster

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    Am so very glad to hear the good news!
     
  12. Dec 5, 2018 #12

    Liung

    Liung

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    Lahi is home and doing good after his sedation, demanding cuddles to make up for all the indignity that he was subjected to today.

    Admire his cute little ears while you can since there’s an excellent possibility that he’ll be losing one next week.

    IMG_0876.jpg

    Also *hoarse wheezing* they shaved his tummy and he is SO OFFENDED!!

    I tried to get him to stand up so I could get a proper picture but he keeps his paws clamped over his bald spot as he stands. HE CAN TELL WHEN HE’S BEING MOCKED AND HE IS NOT HAVING IT.

    IMG_0867.jpg
     
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  13. Dec 6, 2018 #13

    cwebster

    cwebster

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    Hope Lahi continues to do better and better. Really cute bunny!
     
  14. Dec 6, 2018 #14

    Liung

    Liung

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    Haha I love that whoever wrote the patient chart couldn't help but comment on how cute he is <3 my adorable little man!

    Any thoughts/opinions on this "osteoma"? I've literally never heard of this. When the vet said "mineral deposits" on the phone I asked her to repeat herself twice because I couldn't believe the word she was saying could be "mineral". Minerals?? In his lungs???

    ALSO WHAT IS THIS MUSCLE WASTING THEY SPEAK OF?! Why has no one said anything about this previously?! Muscle wasting sounds very concerning!

    upload_2018-12-5_23-57-17.png
     
  15. Dec 6, 2018 #15

    cwebster

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  16. Dec 6, 2018 #16

    JBun

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    That's such great news! I'm so glad he's going to be ok.
     
  17. Dec 6, 2018 #17

    Popsicles

    Popsicles

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    If I remember rightly osteomas are a normal finding in older animals - everything seems to mineralise the older we get! If the vets weren’t worried than I wouldn’t be either. Speak to your vet about the muscle wasteage, but this isn’t uncommon with neoplasia and could be as a result of this. Or potentially as he is a senior.
     
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  18. Dec 6, 2018 #18

    Liung

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    I’m still reserving caution and hope for now—if the tumour has only just started to metastasize, then of course xrays and ultrasounds aren’t going to pick up tumours only a few cells big. It will be quite a while, I think, before we can be absolutely sure that he’s out of the woods.

    Echocardiogram tomorrow to check out the heart murmur!
     
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  19. Dec 6, 2018 #19

    Popsicles

    Popsicles

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    Very sensible, but I still have every hope things will work out positively! Fingers crossed for his echo and surgery.
     
  20. Dec 6, 2018 #20

    cwebster

    cwebster

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    Will be thinking good thoughts for both of you.
     

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