Elder bun with growing mass *help!* (RIP)

[tinybun43]

Hey all,

It's been about a year since I last posted. I'm a college student (pre-vet) going into my senior year. I live about 45 minutes away from school, so my mom is my bunny's caretaker the majority of the time. He get's a handful of Oxbow Timothy T, as much hay as he wants, and fresh parsley about once a day. He is also a chronic sneezer.

About three weeks ago, Tiny, my 9 year old mini-rex had developed a mass about 3-4 cm. The doctor expressed as much as he could of the mass, put Tiny on .25ml of Baytril for two weeks, and that was that. He wanted to do a biopsy to figure out what it was, but financially, my parent's have cut me off for the majority of any more of his vet bills.

In 2008 he went through renal failure and he managed to bounce back after that. Three weeks ago when he went to the vet, his bloodwork showed that his kidney values were borderline. He had lost alot of weight but was otherwise eating, drinking, pooping, hopping around just fine.

Fast forward to today. About Saturday my mom noticed that the mass had doubled in size. Today I took him to the vet. He had gained about a half of a pound, but the mass measured to be just about 7cm. It is on his shoulder, but is growing like crazy and is kind of creeping up towards his neck. Vet tried to express more, but informed me that the mass is completely solid. He said that they could try to remove the mass ($500ish) or keep on keeping on, and when the time came, to humanely euth. Otherwise, Tiny is fine. He's still running around and being his little bunny self.

Does anyone have any advice? There may be a way for me to scrounge the money together, but then I worry about the risk of anesthesia at his age (the doctor was also worried). Should I get a second opinion? The doctor specializes in exotics and is otherwise wonderful. He's been with tiny for his 9 years

. I want to do the right thing for my boy, and I don't want to put him through too much. I want to keep his quality of life where it needs to be.

Thanks for any input or suggestions!

 

[slavetoabunny]

Having the abscess removed surgically would be the best option. If the abscess is not dental or retrobulbar (as in your case) there should be a good prognosis. Baytril is also an "old school" antibiotic for abscesses. I would suggest an injectable bicillin and oral zithromax combo to battle this.

My 7 year old bunny Sparky is recovering from a jaw abscess due to dental root disease. She had major surgery on 12/31/10. She started bicillin/zithromax therapy on 1/11/11 and is still getting every other day injections and daily oral antibiotics. The minimum recommended protocol is 8 weeks. She is doing extremely well and I have high expectations for good long-term outcome. She also continues to be put under anesthesia every week to check her progress with no ill effects.

 

[tonyshuman]

A solid mass may not be an abscess--it is more likely to be a tumor. It is important to figure out what it is to determine what the best course is. If it is a tumor, I would want to make sure he doesn't have cancer throughout his body before going through removal of the lump. This should be done with CT scans if possible, and sometimes x-rays can help. I am concerned because you mention he sneezes a lot, which can be a sign of there being pressure on his cardiopulmonary system. This can be a sign of a tumor of the thymus, an organ located right near the heart. My bunny Benjamin has cancer of the thymus and it is putting a lot of pressure on his heart and lungs, and we discovered this because he was sneezing a lot and it would not go away with a variety of other treatments. If there are a lot of tumors in the body cavity, it may not be very helpful to remove the one you can see on his shoulder.

 

[tinybun43]

Thanks for the responses so far. Vet and I don't think it's an abscess, because it was so solid. Yesterday, they tried to once again remove it, and he wasn't able to. That is why he recomended the surgery. His concern with the growing mass and the small amount of fluid surrounding it was that whatever it is, it's getting infected.

tonyshuman - If he did have a thymoma, wouldn't it be more towards his chest? The lump is on his left shoulder and is creeping toward his neck. I took a picture of it last night.

Once again, input is greatly appreciated. Here's another pic of my boy about two months ago, terrorizing the dog.

 

[tonyshuman]

I am concerned that he has metastatic cancer, and that there may have been a thymoma tumor for a long time that wasn't clinically detectable (like most thymomas), and this shoulder lump represents a metastasis of the original tumor. It also could be that there is no other tumor, but this one extends into his chest cavity, which could be causing the breathing abnormalities. Any physical displacement of the heart, lungs, or airways by a mass can lead to breathing problems. If the lump is indeed cancerous and either extends into the chest cavity or is a metastasis of a thymoma, surgical removal of the lump you can see may not be productive. He may represent a serious surgical risk if his heart or lungs are compromised by a tumor putting pressure on them, either a thymoma you can't see or an extension of the lump into the chest cavity. For instance, our Benjamin has a thymoma that is putting pressure on his heart and lungs and extends throughout his chest cavity. He is not a good candidate for surgery because surgery on the chest cavity of a rabbit is very tricky and often not successful, and he has pneumonia due to the tumor putting pressure on his lungs.

I think the best choice would be to have x-rays done of the chest, CT scans if possible, and a biopsy of the lump you can see if possible. If there are other tumors in his chest cavity, you may want to continue with just providing supportive care, ie antibiotics to control any infection you might be seeing on the lump, pain meds, maybe something to help his breathing (we are doing nebulizing treatments occasionally). If there are no other tumors and the one on the shoulder is fairly encapsulated, it is probably a good idea to have it removed if possible. If not possible, again supportive care like antibiotics to prevent infection can be done. If the shoulder tumor is an abscess, although it sounds unlikely, antibiotics may do the trick. I really think some additional diagnostics need to be done to assess how good a candidate for removal Tiny is.

There is of course a cost-of-treatment versus quality-and-quantity-of-life issue that you have to consider here, so even if he is a good candidate for surgery medically it may not extend or improve his life appreciably. The question may end up being, if he has a moderate chance of success from the surgery, will it give him more happy years? If the tumor is sole, encapsulated, entirely outside the chest cavity, and he has no other conditions that might increase the chance of complications from surgery, it is probably worth it. However at his age and with prior heath problems you will want to ask those questions with diagnostic scans pre-op, especially if the tumor itself is not bothering him.

As an example, Benjamin is really only a candidate for radiation or chemotherapy to reduce the size of the tumor because of his size (dwarf) and its location. He acts like a totally normal bunny right now, and nebulization treatments seem to be helping his lung function. We have decided not to do those treatments because they themselves will make him very uncomfortable, and the extent of the tumor is so great that they will probably not be able to completely eradicate it. We would rather wait until he starts to be bothered by the tumor to decide if it makes sense to try to reduce its size. Otherwise we could go into a never-ending cycle of treatment and relapse that would make him suffer a lot while he undergoes treatment, and probably would not extend his life any more.

 

[Nancy McClelland]

ray:

 

[tonyshuman]

RB thread for Tiny. Sleep peacefully, sweet bunny.
http://www.rabbitsonline.net/view_topic.php?id=68966&forum_id=27