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Cheek/jaw lump returned - treatment/vet/advice please!

E

emeraldislets

New Born Pup
Joined
Nov 10, 2019
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Location
Anglesey, UK
Hi all, after some advice please! One of our tribe has developed a marble/small cherry tomato sized lump in her left cheek/jaw line (again - apologies in advance, it's a bit of a long story!). Exactly the same thing (same place/size/feel) developed back in August - the vet did a needle aspiration and got only blood, so decided it was a haematoma (two days earlier my 9 year old said she had accidentally bumped her face when she put her into the carrier to take her outside, so I guess he put two and two together and decided that was the cause!). He prescribed Metacam and Enrobactin/Baytril antibiotic in case it later developed into an abscess. He examined her teeth and said they looked fine and she was otherwise her usual self with a great appetite and said he thought she'd be too young (7 months then) to have issues from teeth anyway..

This (of course!) happened just before we were due to go make a post-lockdown trip down to see my parents 7 hours away, so our lovely piggy boarder took over giving her meds and keeping an extra eye on her. During that week she went downhill - becoming v quiet and losing her appetite, with the lump getting a bit bigger over the first few days, so the boarder took her to her local vets (an hour down the coast, so not the same guy). This vet assessed, said mouth/teeth and airway look OK and thought that the lump felt too hard to be an abscess - she didn't take a sample but recommended a biopsy when we were home with our usual vet. Piggy started to pick up towards the end of her stay and by the time she got home (and to the end of the antibiotic course), was merrily back to stuffing her face at every available opportunity! The lump hadn't gone down at this point so she found it (as she does with it now) harder to get things in her mouth, so we chopped up any veg for her and gave her vit C and probiotics and plenty of extra TLC! She also took to obsessively trying to eat her Mum's poop (sorry TMI!) - following her around literally head to bottom - presumably her way of replenishing natural gut flora!

We felt like she'd been through a lot and decided to wait a bit for her to put on weight/regain strength before taking her back to the vets given how well she was doing, her age (she's now 11 months - was 7 months at the time) and her not-quite-full-grown stature, having read about haematomas and realising they can take a good while to go. About a week and a half later, the lump got dramatically smaller and by two weeks had completely gone. We didn't notice anything at all on the skin/fur to suggest this had actually been anything other, like an abscess rupture for e.g,. and just presumed it was all resolved internally (retrospectively though we didn't actually check in detail under the fur, which would have been helpful - we were just so pleased it had gone!).

Fast-forward to a couple of days ago, and we wake to find a lump forming in the same place. She's happy enough and has a great appetite - she'll let me touch the lump (feels pretty hard) without making any sort of sound, but I'm not convinced it isn't painful as she will sometimes try and move her head away. At first I wondered whether she had knocked it and it was re-filling but we didn't see anything (she's in with her Mum and 2 sisters and they do like to do zoomies around and under their pigloos and wooden hideys, so it's possible she banged herself!). At first I was relaxed about it and reluctant for any unnecessary needles and meds given her response to the antibiotics (presumably) and that fact that it eventually resolved last time. But today I'm feeling a bit panicked having read more about abscesses and called the vet for an appointment: none today so we're waiting til tomorrow which gives me a bit of time for questions! Being in a relatively rural/remote part of Wales, we have no forum recommended vets for an hour and half or so, and I'm not sure of our vet's cavy experience (I think they see way more farm animals and dogs than piggies for sure and I'm not 100% about the original assessment tbh!) so am wanting to go a bit clued up!

Would welcome any thoughts of more experienced folks (first piggies!) as to possible causes (has anyone had this experience with a haematoma?) but also what the best treatment might be. Is needle sampling the best/only way of assessing what this lump is (I've read a few posts saying this is bad if it is an abscess)? Or are there other options? If it turns out to be an abscess, must this be treated under general anaesthetic or is it possible to do when they are awake (our vet mentioned "surgery" would be needed if it had originally been an abscess..)? Is there a better antibiotic to ask for or should I ask for injection rather than oral to be gentler on her tummy since she didn't cope well last time?

Sorry for the long ramble and to ask so many questions! Feeling quite anxious about the whole thing and definitely keen that piggie has the least invasive/most comfortable/best treatment options we can give her within our limitations! Thanks so much for any thoughts x
 
emeraldislets said:
Hi all, after some advice please! One of our tribe has developed a marble/small cherry tomato sized lump in her left cheek/jaw line (again - apologies in advance, it's a bit of a long story!). Exactly the same thing (same place/size/feel) developed back in August - the vet did a needle aspiration and got only blood, so decided it was a haematoma (two days earlier my 9 year old said she had accidentally bumped her face when she put her into the carrier to take her outside, so I guess he put two and two together and decided that was the cause!). He prescribed Metacam and Enrobactin/Baytril antibiotic in case it later developed into an abscess. He examined her teeth and said they looked fine and she was otherwise her usual self with a great appetite and said he thought she'd be too young (7 months then) to have issues from teeth anyway..

This (of course!) happened just before we were due to go make a post-lockdown trip down to see my parents 7 hours away, so our lovely piggy boarder took over giving her meds and keeping an extra eye on her. During that week she went downhill - becoming v quiet and losing her appetite, with the lump getting a bit bigger over the first few days, so the boarder took her to her local vets (an hour down the coast, so not the same guy). This vet assessed, said mouth/teeth and airway look OK and thought that the lump felt too hard to be an abscess - she didn't take a sample but recommended a biopsy when we were home with our usual vet. Piggy started to pick up towards the end of her stay and by the time she got home (and to the end of the antibiotic course), was merrily back to stuffing her face at every available opportunity! The lump hadn't gone down at this point so she found it (as she does with it now) harder to get things in her mouth, so we chopped up any veg for her and gave her vit C and probiotics and plenty of extra TLC! She also took to obsessively trying to eat her Mum's poop (sorry TMI!) - following her around literally head to bottom - presumably her way of replenishing natural gut flora!

We felt like she'd been through a lot and decided to wait a bit for her to put on weight/regain strength before taking her back to the vets given how well she was doing, her age (she's now 11 months - was 7 months at the time) and her not-quite-full-grown stature, having read about haematomas and realising they can take a good while to go. About a week and a half later, the lump got dramatically smaller and by two weeks had completely gone. We didn't notice anything at all on the skin/fur to suggest this had actually been anything other, like an abscess rupture for e.g,. and just presumed it was all resolved internally (retrospectively though we didn't actually check in detail under the fur, which would have been helpful - we were just so pleased it had gone!).

Fast-forward to a couple of days ago, and we wake to find a lump forming in the same place. She's happy enough and has a great appetite - she'll let me touch the lump (feels pretty hard) without making any sort of sound, but I'm not convinced it isn't painful as she will sometimes try and move her head away. At first I wondered whether she had knocked it and it was re-filling but we didn't see anything (she's in with her Mum and 2 sisters and they do like to do zoomies around and under their pigloos and wooden hideys, so it's possible she banged herself!). At first I was relaxed about it and reluctant for any unnecessary needles and meds given her response to the antibiotics (presumably) and that fact that it eventually resolved last time. But today I'm feeling a bit panicked having read more about abscesses and called the vet for an appointment: none today so we're waiting til tomorrow which gives me a bit of time for questions! Being in a relatively rural/remote part of Wales, we have no forum recommended vets for an hour and half or so, and I'm not sure of our vet's cavy experience (I think they see way more farm animals and dogs than piggies for sure and I'm not 100% about the original assessment tbh!) so am wanting to go a bit clued up!

Would welcome any thoughts of more experienced folks (first piggies!) as to possible causes (has anyone had this experience with a haematoma?) but also what the best treatment might be. Is needle sampling the best/only way of assessing what this lump is (I've read a few posts saying this is bad if it is an abscess)? Or are there other options? If it turns out to be an abscess, must this be treated under general anaesthetic or is it possible to do when they are awake (our vet mentioned "surgery" would be needed if it had originally been an abscess..)? Is there a better antibiotic to ask for or should I ask for injection rather than oral to be gentler on her tummy since she didn't cope well last time?

Sorry for the long ramble and to ask so many questions! Feeling quite anxious about the whole thing and definitely keen that piggie has the least invasive/most comfortable/best treatment options we can give her within our limitations! Thanks so much for any thoughts x
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Although abscesses feel like they are just under the skin, they are usually very much deeper. Therefore, when a needle is stuck into it, it often just produces blood, as it doesn't get anywhere near the actual abscess. However, just a warning that if the needle does penetrate the abscess, it can cause major issues. Often the abscess will then leak under the skin and you get pockets of pus around the area of the original abscess. We had a little piggy arrive here, earlier this year, who had had a fine needle aspiration of jaw lump, which had caused the abscess to leak under the skin and track throughout his whole body, and then burst out through his belly. It took 11 weeks of a combination of strong antibiotics and three times daily flushing of five abscess sites, but we eventually won and it has never returned. I would, therefore, suggest that you don't allow any vet to do a fine needle aspiration of the lump. It is very rare that an abscess will resolve without proper drainage, or complete removal of the abscess capsule. The best antibiotics for dealing with abscesses is Zithromax (azithromycin) or a combination of Metronidazole and Marbocyl. However, you will need the abscess to either be marsupialised (opened up, flushed and stitched open, so it can be flushed daily, while it heals from the inside outwards, or complete removal of the capsule
 
furryfriends (TEAS) said:
Although abscesses feel like they are just under the skin, they are usually very much deeper. Therefore, when a needle is stuck into it, it often just produces blood, as it doesn't get anywhere near the actual abscess. However, just a warning that if the needle does penetrate the abscess, it can cause major issues. Often the abscess will then leak under the skin and you get pockets of pus around the area of the original abscess. We had a little piggy arrive here, earlier this year, who had had a fine needle aspiration of jaw lump, which had caused the abscess to leak under the skin and track throughout his whole body, and then burst out through his belly. It took 11 weeks of a combination of strong antibiotics and three times daily flushing of five abscess sites, but we eventually won and it has never returned. I would, therefore, suggest that you don't allow any vet to do a fine needle aspiration of the lump. It is very rare that an abscess will resolve without proper drainage, or complete removal of the abscess capsule. The best antibiotics for dealing with abscesses is Zithromax (azithromycin) or a combination of Metronidazole and Marbocyl. However, you will need the abscess to either be marsupialised (opened up, flushed and stitched open, so it can be flushed daily, while it heals from the inside outwards, or complete removal of the capsule
Click to expand...
Thanks so much for your reply. I think it was your thread I must've read about a poorly piggy who had issues after a needle aspiration - and that really made me think about how best to tackle this with the vet as I'm pretty certain if we see the same guy he will take the same approach! Do you think this is unlikely to be anything other than an abscess in your experience, and that we just got really lucky the first time round when it seemed to resolve without surgical intervention?

What do you think our best approach would be? To go to our registered vet tomorrow and just ask for an initial assessment (no needles/intervention other than meds) and then pursue (either there or if I can find someone with more specific experience) removal/marsupialisation? Or is there another way they can test the lump for sure without needle aspiration (biopsy, x ray?). Can it be marsupialised under local anaesthetic or is this always a GA? I'm guessing even if this is something other than an abscess that surgical removal under general anaesthetic is the only way to go anyway? I guess I was desperately clinging on to the hope that we could get her through it without surgical intervention -especially when she's still happily carrying on as her normal, greedy, cheeky little self! Thanks so much again for your input - I totally appreciate what an amazing, and time consuming, job this forum's regular contributors do!
 
I just wish you lived closer, so you could see our vet. I've just checked to see how far away you are and I think you would be looking at around 3 1/2 hours each way. Yes surgery is very likely going to be needed. I've had a lot of piggies operated on, with really good results, so with a good operating vet, any risk should be minimal. Our vet deals with so many of this types of issues, that he can tell, just by feeling it, what it is likely to be. It's good she's eating so well and it hasn't affected her teeth.
 
Oh so do I! It's a beautiful part of the world but it really does feel far away sometimes! I will ask around for a small animal specialist tomorrow and start there. Thank you for your words of reassurance - she's such a bright, happy little thing with the sweetest personality - I'm scared to put her through anything but I guess it's just a rock and a hard place kind of situation! Thanks again.
 
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