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Lymphoma diagnosis and palliative care

E

emeraldislets

New Born Pup
Joined
Nov 10, 2019
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175
Location
Anglesey, UK
Hi all, our little Dobby was diagnosed with lymphoma today, after a brief period of lethargy and going off her food. A total shock, especially that it seemed to happen so quickly -from a happy little piggy last week to this.. We were expecting possible teeth issues and a possible chin abscess as the cause (according to vet we saw on Monday, who did a very limited check) but took her to a different vet today for a second opinion on treatment/cause who did a thorough examination could feel swollen lymph nodes all down her, in addition to the one in her chin :(, took a needle sample and confirmed the diagnosis a few hours later.

The vet (we're in the wilds of North Wales!) has been fab but has little experience in this, so is awaiting advice from Birch Heath as to possible supportive treatment/doses etc. But to be honest, it already feels like were close to the end - after 3 days of syringe feeding (critical care) and selective nibbling, today she is not having any of it - pushing the syringe away, declining all of the most delish treats.

Looking for a bit of advice and hand holding if possible please - she's the first of our 5 piggies to reach this stage and I just want her to be comfortable. She is increasingly withdrawn - only venturing out of a hidey under duress. She was prescribed cat Metacam on Monday and today's vet said to continue with it (and stop the Emeprid) at a dose of 0.2ml once a day (she weighs a kg).

I asked if I could give more than the once daily dose and she said no, but I would welcome thoughts as to whether it's possible in this situation.
Also, what do we do with feeds? I was aiming for a min of 45mls of critical care, previously able to get about 5ml in each sitting but she's had a total of about 6ml since this morning - and wanted none just now. Do I persevere or accept that this refusal is just part of the process? Should I insist or just offer some other way (she's not a massive critical care on a good day so I wouldn't have expected her to eat it off a spoon anyway!)? And do I need to syringe water or again only if she takes it when offered?

I hate to keep getting her in and out of her bed to keep trying if it's making her stressed and uncomfortable but it's also hard to let go and not try and syringe feed.

She lives in an indoor run with 3 other girls, who devour anything I put out for her before she has the chance to if she wanted! Should I separate her or just leave them be for comfort?

Sorry for so many questions - feeling sad and overwhelmed after a stretch of late nights feeding. Hope that more experienced members can offer their wisdom. Thanks in advance x
 
I’m so sorry about Dobby’s sad news, sending big hugs x
I have no experience of Lymphoma, so can’t really give you any advice but just wanted to offer support. I would keep her with her friends though. Can you maybe take your other girls out for 15 minutes floor time which would give her time to eat?
 
I’m so sorry to hear about your little Dobby. My Jellybaby received a lymphoma diagnosis last week after having a lump removed. I‘m sending big hugs ❤️ because I know how heartbreaking it is. Jellybaby was on dog Metacam after his operation but is now on Prednisolone, a steroid. Steroids and anti-inflammatories like Metacam must not be given together. I do hope Birch Heath can provide some good advice - it has to be individual to your little piggie due to the nature of lymphomas. Far more experienced owners here can provide advice on feeding if your little one won’t take it. I alternate between Oxbow and Emeraid. Are you weighing her daily? Will she take any hay or cc if fed in a cosie where she feels less vulnerable? She may also be nibbling at night. Sorry I can’t offer more helpful advice - you’re obviously doing all you can. Please remember to be kind to yourself too x
 
emeraldislets said:
Hi all, our little Dobby was diagnosed with lymphoma today, after a brief period of lethargy and going off her food. A total shock, especially that it seemed to happen so quickly -from a happy little piggy last week to this.. We were expecting possible teeth issues and a possible chin abscess as the cause (according to vet we saw on Monday, who did a very limited check) but took her to a different vet today for a second opinion on treatment/cause who did a thorough examination could feel swollen lymph nodes all down her, in addition to the one in her chin :(, took a needle sample and confirmed the diagnosis a few hours later.

The vet (we're in the wilds of North Wales!) has been fab but has little experience in this, so is awaiting advice from Birch Heath as to possible supportive treatment/doses etc. But to be honest, it already feels like were close to the end - after 3 days of syringe feeding (critical care) and selective nibbling, today she is not having any of it - pushing the syringe away, declining all of the most delish treats.

Looking for a bit of advice and hand holding if possible please - she's the first of our 5 piggies to reach this stage and I just want her to be comfortable. She is increasingly withdrawn - only venturing out of a hidey under duress. She was prescribed cat Metacam on Monday and today's vet said to continue with it (and stop the Emeprid) at a dose of 0.2ml once a day (she weighs a kg).

I asked if I could give more than the once daily dose and she said no, but I would welcome thoughts as to whether it's possible in this situation.
Also, what do we do with feeds? I was aiming for a min of 45mls of critical care, previously able to get about 5ml in each sitting but she's had a total of about 6ml since this morning - and wanted none just now. Do I persevere or accept that this refusal is just part of the process? Should I insist or just offer some other way (she's not a massive critical care on a good day so I wouldn't have expected her to eat it off a spoon anyway!)? And do I need to syringe water or again only if she takes it when offered?

I hate to keep getting her in and out of her bed to keep trying if it's making her stressed and uncomfortable but it's also hard to let go and not try and syringe feed.

She lives in an indoor run with 3 other girls, who devour anything I put out for her before she has the chance to if she wanted! Should I separate her or just leave them be for comfort?

Sorry for so many questions - feeling sad and overwhelmed after a stretch of late nights feeding. Hope that more experienced members can offer their wisdom. Thanks in advance x
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Hi

HUGS
I am very sorry for the diagnosis. It is one that none of ever wants to get. :(

It is normal to feel all at sea and overwhelmed, as well as very gutted and heart-sore; you are dealing with both the shock and the onset of your grieving process at once right now. Grieving starts as soon as you realise that the end is inevitable, not with the actual death. In the whole experience, this moment is the second worst time apart from the actual loss.

Please keep your girl with her mates; they are very important for her comfort and support but you can take her out for feeding time. Please switch from the normal once weekly weigh-in to weighing daily at the same time (I prefer first thing in the morning) so you can step in and adjust your support feeding level for the day - but make sure that you do not feed more than she is willing to take and able to process. It is better for terminally ill piggies that you go along with what they want and not what you want for them; and that they are as comfortable and stress-free as possible.

You should find the very practical tips (including how to avoid overfeeding terminal piggies and give them control) and in-depth advice and information in these links here helpful for the coming days and weeks:

Practical illness support care (the guide contains further links on special aspects); pain is very much an appetite killer: All About Syringe Feeding and Medicating Guinea Pigs with Videos and Pictures

Recognising signs of pain: Signs of Pain in Guinea Pigs

End of life care: practical, emotional and ethical challenges and when to call it an end: A Practical and Sensitive Guide to Dying, Terminal Illness and Euthanasia in Guinea Pigs
 
So sorry that you received such an awful diagnosis.
It feels as if the bottom has fallen out of the world when you get news like that.

I can’t add to the practical care advice already given but do make lots of happy memories, take lots of photos and remember that piggies live for today.
Also, news like this kicks off the grieving process so be gentle with yourself.

Holding you in my heart ♥️
 
I’m so sorry that you’ve received this diagnosis. I’ve nothing to add but to offer support at this dreadfully sad time.
 
I am so sorry you have received this diagnosis. It is a heartbreaking illness that always comes as a huge shock because it appears to come out of the blue and often progresses very quickly and sadly can not be cured. I have experienced it a few times over the past 20 years the most recent being at the start of this year. From your description I very sadly agree with you that you are likely to be near the end. It is such a hard place to be. In deciding how much and if to syringe feed I would be guided by Dobby. Dealing with end of life is not the same as maximising how much you feed to get someone through an illness and out the other side, so forcing a lot into her if she is strongly resisting may not be the way yo go. Her quality of life is the top priority, I would do what causes her least distress while keeping her comfortable and try to make the most of the time you have left together. I really wish I could be more positive but am speaking from my personal experiences. Also as hard as it is, you may need to prepare yourself to make the decision to help her over the rainbow bridge.
Sending you hugs and my best wishes x
 
Thank you so much everyone for all your messages. We are absolutely gutted - she is the sweetest natured little piggy and we'll miss her so much. I gave metacam last night and offered, but didn't insist, upon food and water from the syringe. She wasn't interested and I made the decision then just to offer food and leave her to be in her bed instead of having to pick her up and stress her anymore. I made sure there was lots of food around her (and near the other piggies and in a separate area so there would be plenty for her to nibble on) - she took a few mouthfuls of soaked pellets and then we all went to bed and left them warm, and in peace.

She's still here this morning, is lying quietly next to her mum on lots of fleece blankets in a hidey. I've offered more food and water but she's not interested, so have stocked up near here and we're trying just to leave her in peace.
She's so calm, and is just lying with her eyes open - the odd sound of laboured breathing (as if she had wolfed her food and is doing that characteristic 'ate too quickly' noise) but otherwise all peaceful. It's hard to see though as she's obviously so weak and sad looking. I'm thinking I will try and give metacam again if I can but not pick her up, just see if she will take it where she is, and the same with food/water.

It's so counter all instincts to leave her be and not pick her up and keep on trying but I guess she is telling me that she's done. If she was into her food even just a tiny bit, I'd fight with her and consider next steps for prolonging her life, but I'm just not getting that feeling. How do I know if she should be PTS though? I really hate the thought of her suffering or in pain and would make that decision if there were obvious signs. The vet is about 20 mins drive and will inevitably be stressful..
From folks who've made this decision, what were your signs the PTS would be kinder? To be honest, I really didn't expect to find her still alive this morning so the thought yesterday was just not there.. Can death be peaceful and relatively pain-free in this scenario or am I making her wait longer than need be? So torn today, it's a horrible, horrible situation ;( Thanks again for everyone's support, it means so much ❤️
 
emeraldislets said:
Thank you so much everyone for all your messages. We are absolutely gutted - she is the sweetest natured little piggy and we'll miss her so much. I gave metacam last night and offered, but didn't insist, upon food and water from the syringe. She wasn't interested and I made the decision then just to offer food and leave her to be in her bed instead of having to pick her up and stress her anymore. I made sure there was lots of food around her (and near the other piggies and in a separate area so there would be plenty for her to nibble on) - she took a few mouthfuls of soaked pellets and then we all went to bed and left them warm, and in peace.

She's still here this morning, is lying quietly next to her mum on lots of fleece blankets in a hidey. I've offered more food and water but she's not interested, so have stocked up near here and we're trying just to leave her in peace.
She's so calm, and is just lying with her eyes open - the odd sound of laboured breathing (as if she had wolfed her food and is doing that characteristic 'ate too quickly' noise) but otherwise all peaceful. It's hard to see though as she's obviously so weak and sad looking. I'm thinking I will try and give metacam again if I can but not pick her up, just see if she will take it where she is, and the same with food/water.

It's so counter all instincts to leave her be and not pick her up and keep on trying but I guess she is telling me that she's done. If she was into her food even just a tiny bit, I'd fight with her and consider next steps for prolonging her life, but I'm just not getting that feeling. How do I know if she should be PTS though? I really hate the thought of her suffering or in pain and would make that decision if there were obvious signs. The vet is about 20 mins drive and will inevitably be stressful..
From folks who've made this decision, what were your signs the PTS would be kinder? To be honest, I really didn't expect to find her still alive this morning so the thought yesterday was just not there.. Can death be peaceful and relatively pain-free in this scenario or am I making her wait longer than need be? So torn today, it's a horrible, horrible situation ;( Thanks again for everyone's support, it means so much ❤️
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Hi

I have posted the link in my previous post, but here it is again. I contains a whole chapter on pts, including how to judge when the right time has come; the chapter on terminally ill piggies also touches on it. There is not a firm cut-off point but a grey area in which there is no right or wrong - it just depends on which factors in play you value higher.

Here is the link again. Please read it. You will find that it will help you with making any necessary decisions and also helps to ease the feelings of failure/guilt and intense soul-searching a little that always come with the loss of a beloved one.
A Practical and Sensitive Guide to Dying, Terminal Illness and Euthanasia in Guinea Pigs
 
Thank you Wiebke - for the work you put in to writing and sharing your guides - and just being there to support us through ❤️ I spoke to the vet earlier this afternoon and she agreed that the kindest thing was to put Dobby to sleep. So my husband is there with her now. It's heart-breaking but ultimately feels like it was far better to help her across the Rainbow Bridge than watch her struggle on for more hours/days with no hope of recovery. May she be pop-corning her way across. We'll miss her so much 💔
 
I’m so sorry to hear about your lovely Dobby. It is a heartbreaking decision to let them go but you clearly gave her much love and care. Thinking of you and your other girls ❤️ x
 
Lymphoma is a beast and the outcome is never good, so you made the right decision for Dobby.
I am so sorry you had to go through this, but be kind to yourself and remember that you made the right choice and didn't allow her to suffer.
Thinking of you and your family tonight.
 
emeraldislets said:
Thank you Wiebke - for the work you put in to writing and sharing your guides - and just being there to support us through ❤️ I spoke to the vet earlier this afternoon and she agreed that the kindest thing was to put Dobby to sleep. So my husband is there with her now. It's heart-breaking but ultimately feels like it was far better to help her across the Rainbow Bridge than watch her struggle on for more hours/days with no hope of recovery. May she be pop-corning her way across. We'll miss her so much 💔
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BIG HUGS
I am so very sorry; but if it is any consolation to you, I would have made the same decision at that stage. It is always heart-breaking and gutting but knowing that you have spared Dobby any unnecessary suffering and have given her the most precious of gifts that we can make a beloved pet will hopefully ease some of the soul-searching and feelings of failure. When chips are down, we'd rather hurt a bit more in order spare those we love any more suffering. You have done that, as painful as it is.

Anyway, I am very sorry that you haven't had a bit more of a gap between the bad news and the letting go to digest the initial shock; it is always harder having both the shock and the loss on your plate at once. Please be kind with yourself and concentrate on looking after Dobbie's friends.
Here is our human grieving guide to help you deal a bit better with all the often strong but unexpected emotions and emotional swings in the coming days and weeks: Human Bereavement: Grieving, Coping and Support Links for Guinea Pig Owners and Their Children

What you can do for any companions in the immediate wake and longer term (the latter more crucial for widowed singles). Please give them time and space to do their own grieving, as hard as it is for you as an owner to stand by: Looking After a Bereaved Guinea Pig

PS: Admittedly, the Dying Guide has been the most difficult and painful guide I have ever written (so many very personal experiences...) but there is a clear need and no practical hands-on guidance around; most - rather scant - information is kindly meant but too vague to be of use when you are swamped with emotions or panicking outright; especially when it is your first experience with death or euthanasia/pts.
Knowing that the guide really does help makes it worth my personal pain. Thank you.
 
So very sorry you had to make that tough decision for Dobby.
It’s heartbreaking but it is also a gift of love.
Be gentle with yourselves as you grieve.
 
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