The Latest On Lincoln

HelenRB

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Lincoln's medical saga continues (apologies for length!)...

I've previously posted about Lincoln's diagnosis in May of early-stage kidney failure, and how he then wasn't eating much and seemed to be showing symptoms that didn't make sense for his stage of kidney disease.

I am just back from two weeks of vacation. Before I left, Lincoln had seemed to be stable and was eating fairly well. He stayed with good friends of mine who have experience with high-needs pets and were up for giving him his sub-q fluids, which I was doing every 3 days.

Lincoln did great for the first week, then his eating slowed down again. A good friend of my friends, who is a very experienced vet, went to their place for dinner last weekend and had a look at him. She immediately thought he was experiencing oral pain. I had thought that too, but my vet had said his teeth didn't look all that bad so I thought that couldn't be it. This vet looked inside his mouth with a flashlight, and could see a mass growing toward the back on his jaw. His lymph nodes on his left side also felt swollen.

My friends took Lincoln to my vet clinic, which confirmed the mass growing in his mouth and suggested I consider a biopsy when I get back. They said they couldn't tell whether the mass was cancerous or an infection. Lincoln got more antibiotics (he's already had a few rounds) and oral buprenorphine, and my friends were told to start giving fluids daily.

Lincoln HATED the oral buprenorphine, and actually seemed to deteriorate once that started. He hid all the time, and eventually stopped eating completely. My friends took him back to the vet, who gave him a shot of long-acting buprenorphine so that they wouldn't have to torture him with the oral stuff every day. Everyone was worried he wouldn't make it until I got home.

I just picked him up today. I'd been getting emails from my friends and was expecting him to be at death's door, but he was quite chipper and snuggly, and had eaten a few meals since yesterday.

A swelling on the side of his face is definitely visible (probably the more so as I haven't seen him for two weeks). It has clearly grown quite quickly.

I did schedule the biopsy, but it isn't until July 3rd. It will be somewhat risky for him as it'll involve anaesthetic, and he has a heart murmur. It is also pretty expensive, and I'm a bit worried that the outcome, whatever it is, will involve even greater expense.

I plan to go in to the vet this week just to talk with them.

I am not sure what to do from here. I think my focus is going to be on quality of life rather than length of life. He just utterly and completely hates going to the vet or getting any kind of medication - it destroys his trust in me and makes him spend all his time hiding. I think I will lean away from invasive treatment unless there is a real likelihood that it will help him. But, I've still got more to learn.

That said, on days like today he is jumping up onto the counter to be brushed and purring like a freight train. At this stage, I am just completely confused!
 

danteshuman

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:vibes::grouphug2:

I’m so sorry your baby is going through this. Without the kidney failure being part of it I would do the biopsy. I think you should listen to your heart and follow your instincts. You will know when it is time to let him go. I would also start calling around and see if there is a mobile vet clinic that can come to your house to treat him/biopsy him (if you choose.) Plus it will make his passing much more peaceful if it happens at home, when the time comes ...... hopefully years from now.

I understand the comfort over length of life decision. I made that choice for my sweet bud Dante. Once I stressed to the vet that I wanted him to be comfortable she told me I was doing the right thing (I came in saying ‘I hope I’m wrong but my gut says it is time.’) My only regret is not calling a mobile vet so his last bit of time could have been less stressful.

I included a poem for you to think about when your heart tells you it is time:
 

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HelenRB

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Thank you both, and thank you for the beautiful poem Danteshuman. I really do not think I'll want Lincoln to linger if his life is just going to be full of things he hates.

But, I think if we can make it to July 3rd I'll do the biopsy and learn what I can. Maybe it's something that can be helped with a one-time or relatively brief treatment, and that would be worth it.

He is so cheerful today that I'm hesitant to give him his fluids and Mirtazapine, even though I am supposed to. I think he's happy to have me back, which is a lovely feeling. Maybe I'll wait until bedtime and then he can sulk overnight and feel better in the morning.
 

Jem

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My boy with CKD was very prone to mouth infections. One time he got such a bad one that the whole side of his face (cheek/under the eye) swelled right up. Although it did mean antibiotics several times, he always bounced back when the infections were under control. I hope in your case it's just an infection and can be treated quickly. I'm glad he seems to feeling better too.
 

FeebysOwner

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Hi. So sorry to hear about Lincoln's most recent issue. :alright:

I don't know if it even possible, but when you go to talk to the vet, could you ask if a needle aspiration of the growth is possible and avoid anesthesia? Maybe they could give him something to help slightly sedate/relax him, if so.
 
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HelenRB

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Jem, that is really interesting. The vet did say infection was a possibility. He has a mild fever and runny nose.

FeebysOwner, I’ll ask about that. In the notes it says they recommend a biopsy under sedation or general anaesthetic, so maybe if sedation is enough they wouldn’t do the general. That would certainly be better.

He’s still very sociable tonight but has hardly eaten a thing. I gave him fluids and his mirtazapine, and he sat very patiently and didn’t hide on me afterwards.

In this photo you can kind of see the swelling on his left side (you can also see the table that he vastly prefers to sit on instead of his fancy cat tree :rolleyes3:).
 
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HelenRB

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I wonder if the growth in his mouth is affecting his breathing, as he is making a snorting sound a lot of the time - like a pig grunt.

He isn’t really eating anything, or even drinking the Whiskas cat milk he normally loves.

I’m offering food but not pushing it too hard, as he seems to be quite contented, and if he doesn’t have a lot of time left I don’t want to fill it with stress. He demanded cuddles at 3:00 this morning like he always has (which drove me crazy just a few months ago when he first came to live with me, but now I treasure that time).

I’ll give the vet a call today.
 
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HelenRB

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I made an appointment with the vet on Wednesday, but when I went home to check on Lincoln at lunch he was back to hiding behind the couch and he looked so miserable that I asked if I could bring him in this afternoon.

The vet thinks the tumour in his mouth is actually fusing his jaw shut. She is pretty sure it's cancer, given the multiple courses of antibiotics he's had, and the way it has progressed over the past few months.

She thinks general anaesthesia would be necessary to do the biopsy because she could not open his mouth. We talked about possible outcomes of that, and how he is likely to be feeling right now. I do not want to put him through that only to give him a few more months of life where he has to be medicated and have frequent vet visits.

She gave him a long-acting shot of buprenorphine.

I kept the Wednesday appointment and we're going back then to check in, but I think the plan is probably to say goodbye to him then. It feels a bit surreal. I'm going to give him all the love I possibly can between now and then.
 
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HelenRB

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I said goodbye to my dear boy this morning.

The vet said the tumor had grown since she saw it last week and was pressing on his windpipe, as well as fusing his jaw shut. It was very aggressive and he was beginning to have respiratory problems, and obvious pain. We talked about quality over quantity of life, the location and growth of the tumor, the fact that he was a poor candidate for anaesthesia (weak and a fairly severe heart murmur), and how much he hated having things done to him.

She was extremely kind and his passing was peaceful and painless, but I'm a bit of a mess. He was the gentlest, most affectionate cat and was filled with love for everyone - even other cats and dogs.

We had a beautiful last night and quiet morning together. I'll write something more in the other section when I feel up to it. Thanks to everyone for all of the help I have had on this forum.
 
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