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Experience Of Palliative Care/end Of Life Advice Request

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Lady Kelly

Lady Kelly

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I don't know who will remember I requested advice on Peter last January after being told that it feels like his lymph nodes were swollen so it was likely he had lymphoma. Anyway, January 2016 comes round and Peter is still with us so I am assuming that vet (not my usual vet) was wrong.

History:
Peter came to me 5 years ago in April at around 1 year old. He was intact and I had him neutered to live with Bumble and Bea.
When Peter was around 3 years old he had a lump come up on his belly so I took him to the vet who tried to get biopsies but they proved inconclusive. In the end we opted for an operation to remove and find out what was going on. Poor Peter had a ton of tiny lumps in him and the vet took 3 for testing. It turned out just to be fatty lumps so I continued to monitor him.
Last year he was using his back leg a bit oddly (having to lift it very high) because of the positioning of two lumps. He has about 5 palpable lumps with two of them being immediately visible to look at him (they are quite huge). This is when I got told he had lymphoma and due to his age an operation would be incredibly risky and that you run the risk of spreading the cancer.
Well up until now there hasn't been much to report, I think the main lumps may have got a tiny bit bigger and Peter did gain some weight. A couple of months back he started with a bit of dirt around his bottom so I cleaned him regularly (much to his displeasure).
On his health check this week he has lost weight for the first time in ages (he currently weighs 1190g as he was always a big lad) but the mess had spread from his bottom and up to his chest in a thin line.

Obviously I know that the mess and weight loss is likely to be from him getting uncomfortable and maybe not being able to move around as easily (though he still runs up the ramp at veggie time and rumbles at the girls). My main concern is to not have him suffer. Should I be going to the vet to look at pain relief or is it unlikely to make a difference to him making a mess of himself? I just want to make sure I'm not keeping him going for my benefit only.
 
I'm currently providing palliative care for my Penfold. I would say as he is losing weight and messing around the backend this would indicate not moving around as much which is most likely due to pain and discomfort.

My Penfold, has kidney stones and his Kidneys are failing. Since we have got his pain under control he moves around much more, eats like a trooper and is gaining weight the difference between pain killers and no pain killers is unmistakable. We have a duty of care to keep them as comfortable as possible. If you can improve quality of life, and extend life with pain killers it is most definitely worthwhile.

There is no harm in discussing pain management with the vet. My Penfold is on Tramadol but there is no doubt he is in a huge amount of pain but it's manageable. Just last week before we increased his dose I was discussing pts. It was the vet who advised tweaking his medicine as I was sure it was unmanageable. He may only have a bit longer but the time he does have is enjoyable and that's all we can hope to achieve.

Give Peter a gentle stroke from me, he's very lucky to have such a caring owner.
 
Lady Kelly said:
I don't know who will remember I requested advice on Peter last January after being told that it feels like his lymph nodes were swollen so it was likely he had lymphoma. Anyway, January 2016 comes round and Peter is still with us so I am assuming that vet (not my usual vet) was wrong.

History:
Peter came to me 5 years ago in April at around 1 year old. He was intact and I had him neutered to live with Bumble and Bea.
When Peter was around 3 years old he had a lump come up on his belly so I took him to the vet who tried to get biopsies but they proved inconclusive. In the end we opted for an operation to remove and find out what was going on. Poor Peter had a ton of tiny lumps in him and the vet took 3 for testing. It turned out just to be fatty lumps so I continued to monitor him.
Last year he was using his back leg a bit oddly (having to lift it very high) because of the positioning of two lumps. He has about 5 palpable lumps with two of them being immediately visible to look at him (they are quite huge). This is when I got told he had lymphoma and due to his age an operation would be incredibly risky and that you run the risk of spreading the cancer.
Well up until now there hasn't been much to report, I think the main lumps may have got a tiny bit bigger and Peter did gain some weight. A couple of months back he started with a bit of dirt around his bottom so I cleaned him regularly (much to his displeasure).
On his health check this week he has lost weight for the first time in ages (he currently weighs 1190g as he was always a big lad) but the mess had spread from his bottom and up to his chest in a thin line.

Obviously I know that the mess and weight loss is likely to be from him getting uncomfortable and maybe not being able to move around as easily (though he still runs up the ramp at veggie time and rumbles at the girls). My main concern is to not have him suffer. Should I be going to the vet to look at pain relief or is it unlikely to make a difference to him making a mess of himself? I just want to make sure I'm not keeping him going for my benefit only.
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I would speak to your vet about pain management and when to draw the line. Weight loss is most often a good indicator that he is in pain.

It is not easy to find the right moment, as we feel all differently on that subject; it has to be right for Peter and you. Any good vet will be prepared to talk about this honestly if you ask them.

I have currently got my Tanni with an inoperable large lump...
 
I agree with Jo that once he is on pain relief you may notice a big difference. Definitely worth discussing with your vet. Otherwise just take each day at a time and let him be your guide, we are doing the same with our Katie at the moment.
 
Thank you guys for your responses. I know it's a difficult subject and after managing both Bumble and Bea with pain relief at the end of their lives just last year I did figure a chat to the vet might be the best option. I shall speak nicely to my OH about popping us over there so it might have to be at the weekend. It's the first week that Peter has lost any weight in over 6 months so I am hopeful that if he is starting to suffer that it is really only the start of him going downhill. If I'm honest with how I feel I am not ready to lose another piggy right now not after Bea this time last year and Bumble in October but then I wouldn't be selfish and keep him going if he wasn't enjoying life.
 
Well this weekend Peter is showing signs of getting dirtier despite gaining a little weight again. He has the very start of what I am certain is a urine scald and is booked in with the vet tomorrow night. I have been up front that the appointment is to discuss end of life care so will see what happens tomorrow and whether he improves with any medication at all.
 
My thoughts are with you, I hope there's something more that can be done. I know just how difficult it is the worse Part of pet ownership.
 
Huge hugs Kelly, he has a great mom who will always do the best for him X
 
Thanks guys, I will update you after I know more. I feel sad as Bumble went quickly at this stage and the OH was away so didn't get to say goodbye. Now the OH is working away again for 3 weeks from this weekend so worried it will happen again and I'll be on my own for it and he might not get to say goodbye. In a way it's silly, I can't control what will or will not happen and also we were told last year he was at the end of his life and here we are a year later.
 
I know how you feel, I'm facing a similar appointment tomorrow. I've been fighting that Sad feeling for the last couple of days - I really hope there is something more that can be done for Peter.
 
flintstones said:
I know how you feel, I'm facing a similar appointment tomorrow. I've been fighting that Sad feeling for the last couple of days - I really hope there is something more that can be done for Peter.
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So sorry you are going through this too. It's far from the easy and enjoyable side of having piggies but needs must and all that. I'm so stressed at the moment that I think I'm perhaps stressing too much over this as well. Hope your appointment goes as well as it can today.
 
Lady Kelly said:
So sorry you are going through this too. It's far from the easy and enjoyable side of having piggies but needs must and all that. I'm so stressed at the moment that I think I'm perhaps stressing too much over this as well. Hope your appointment goes as well as it can today.
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It's hard not to stress it's such a final decision, I have already discussed put to sleep twice and decided little Pen still had some chance of recovery, today he will be making his final journey. It's very apparent he's not happy and it isn't an episode he's likely to overcome. Have strength, and let Peter lead you I know my Pen has made it clear. X
 
I know how you feel.... Our H is on ever increasing doses of metacam at the moment and losing weight too. As long as he can be kept comfortable and isn't in distress then we will continue...

I work away from home and dread losing another piggy while I am away but it is almost inevitable as I am away for some of the week most weeks. I just make sure I kiss him goodbye like it's the last time, every time and then I can be as regret free as I can...

It's such a hard time for owners and it's great to see so many of us understand each other's predicament and can support each other at these times. Not so good that there are so many poorly piggies but I guess age and/or illness come to us all at some point.

You are doing your absolute best for him and love and no pain count for a lot so do what you feel is right for him and I hope it all goes as peacefully and stress free as possible. x
 
Well we are home from the vets, what a nightmare. It usually takes 20 mins, maybe 30 in traffic but tonight was gridlock. 60 mins it took to get there, I phoned them en route and they said they would still see us so we persevered.

Amie took a couple of samples from lumps to check and one was definitely a fatty lump but the one on the top of his back leg is a subaceous cyst! I wasn't expecting that because it wasn't mentioned last year when I took him to the not so savvy vets who were certain he had lymphoma. All I can say is, despite feeling a bit queasy with a dodgy stomach already today, the thought of eating cheese is definitely not one I want to think about after how Amie described the consistency!

In all other respects Peter is a fully healthy and quite lively guinea pig. When we got there he was proudly playing king of the castle (with the castle being a humongous pile of poops!) and then as soon as the vet touched him he squealed (because he's a big drama queen!). She did a full health check and agreed that he certainly didn't seem to be ready to leave us just yet. So we now have metacam 0.25ml once a day to see how he goes though I have been warned that if he's not moving enough from the sheer weight of the lumps that the pain relief might not make much difference.

Thank you again to everyone on here, I think I would lose my mind a million times over without you guys to vent my spleen to.
 
Aw good news, and Peter sounds like he was on form to. Glad it's not Peter's time yet, and when it is his time you won't be questioning your decision you'll know! In the meantime enjoy the little man and spoil him :).
 
Good news! These little ones do like to put us through the mill but glad that he can stay with you relatively fuss free for hopefully a fair old time more...

Hugs to you and Peter. x
 
Peter has been back to the vet today for a review as his medication ran out. I have managed to get him comfortably down to 0.2ml once a day. He is still bright and holding his weight very well and hasn't lost a lot at all over the past few weeks. I have been given enough metacam for 3 months now and the vet wants to see him in 3 months to review. Think he will be with us for a little while at least
 
Lady Kelly said:
Peter has been back to the vet today for a review as his medication ran out. I have managed to get him comfortably down to 0.2ml once a day. He is still bright and holding his weight very well and hasn't lost a lot at all over the past few weeks. I have been given enough metacam for 3 months now and the vet wants to see him in 3 months to review. Think he will be with us for a little while at least
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that is wonderful news!
 
Well Peter has started to go downhill a bit quicker now. I did tell him I needed at least a month after my dads passing and its been that so he did listen to me. I've reduced his metacam to around 0.18ml but he's dropping weight a bit more quickly and is now nearly down to 1kg, I can feel his spine and shoulders. He is struggling a bit but still running around. The lump on his neck from beginning of may has about tripled in size so I am wondering whether this is an abscess and if so whether it is worth subjecting him to treatment given his situation. It's not impacted on his eating at all so I'm not sure what to do but might call the vets on Tuesday for some advice.
 
Well I can't quite believe this but then neither can the vet that's treating him. Despite starting metacam in January, I have managed to get his dose right down to 0.1ml once a day. He is still very much lively and has his appetite, in fact he's even gained some weight since 3 months ago when he last saw the vet. I now have another load of metacam to keep him on, at 0.1ml it should last 6 months but I know I can increase up to 0.25ml again if needed. This little boy has certainly got the fighting spirit that his late wife Bea showed
 
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