A couple of years ago, Louis (pic
) a neighborhood cat, possibly anticipating Romney talking points, semi-adopted us (wife+me) - he's a freeloader outdoor cat that comes in to eat and get medical treatment, but does no work around the house, except when he marks the territory as his (and then the work of cleanup falls to us). It is our understanding that he's about 11-12 years old.
March of last year, the lymph nodes under his jaw were swollen - on both sides of the neck, symmetrically. The vet prescribed anti-biotics, and Louis recovered well. He also got a bunch of vaccinations that were considered prudent.
January of this year, we had him operated upon to take out a skin abscess(?) that was not healing for a long time. It was a lump/growth right behind his left front shoulder blade - the lump finally broke through the skin resulting in blood/plasma discharge that Louis would continually lick. When this did not heal after months, we decided to take it out. The abscess/lump was not biopsied to see if it was cancer or whatnot, but he recovered very well, though it was a challenge to keep him indoors for a couple of weeks. When he was brought back to have his stitches taken out, his vaccinations were re-upped.
Last Friday evening he came in for dinner as usual, and we noticed that the left side of his face was significantly swollen - the size of a large golf ball - stretching from under his eye to the neck area. His appetite was not affected, and as usual he ate heartily.
Saturday morning we took him to the vet. The vet examined him - the swelling is a hard mass slightly above and below the jaw, basically hugging the jaw on one side. The vet couldn't tell the origin of the swelling, but speculated it might be a tooth abscess or possibly an infection from a cat fight. However, as long as the swollen mass was hard, he could not operate to "drain" it of puss. He recommended warm compresses and antibiotics on schedule and a return visit Monday (today). The cat also got an immediate anti-biotic shot and had his blood drawn for analysis.
Over the weekend, we kept Louis indoors, but his appetite was uncharacteristically gone - he hardly ate or drank at all - and he was very enervated, sleeping and hardly moving for 20+ hours. He got all his anti-biotics on schedule, and a couple of warm compress treatments, though we stopped the latter as he was very uncooperative with those.
Sunday evening the swelling was significantly down from his face overall, but the hard mass remained, now concentrated and more distinct around his jaw.
Monday morning (today) we took him back to the vet. Upon examination, the vet said that the mass was still hard and therefore he could not operate to "drain" any possible puss. He said the blood lab work came back normal, including normal values of white blood cell count. He said that there are three possibilities:
2)Infection from cat-fight.
He wants us to continue with the warm compresses and the anti-biotic regimen, and come back Friday. If by Friday the swelling doesn't go away and the mass doesn't soften, he will have to perform a biopsy on the mass.
Louis seems back to his old self as far as appetite and behavior goes, (though possibly 5% less lively - hard to say).
However, once we got back and started thinking about the whole thing, we were left with questions - hence this post.
Basically, we want to know if having the biopsy is a good course of action come Friday, assuming the swelling does not go down or soften. Putting him under anesthesia is always a risk and we'd like to avoid as much of such an ordeal, as possible, unless there are clear medical benefits or indications.
What will a biopsy tell us?
Of the 3 possibilities outlined, can one diagnose #1 - tooth abscess - without a biopsy? Perhaps through an X-ray (does an X-ray also involve putting him under?)? How does one diagnose a tooth abscess in a cat (the vet looked inside his mouth but couldn't tell anything other than that Louis has the teeth of an elderly cat - and yes, we've been brushing his teeth every couple of days the past few months).
Possibility #2 - infection as a result of a cat fight. What does a biopsy do for us here? Doesn't it make sense to let the antibiotics take their course first and thus eliminate/confirm the "infection" diagnosis through the swelling either disappearing or not? What does a biopsy buy us here? The key, it seems, is to eliminate possibility #1 (tooth abscess) as a source of the infection through some other means (X-ray?) first so that the tooth can be taken care of instead of continuing to cause problems once the antibiotics treatment stops. But either way, shouldn't we give the antibiotics time to work before we do a biopsy should that fail? Also, if it's an infection that causes that much swelling shouldn't the white blood cell count have been elevated?
Possibility #3 - cancer. If it's cancer, presumably the swollen mass itself is not the cancer, because it's highly unlikely to have sprung that big from one day to the next. Therefore presumably it's a swollen lymph node in response to cancer. But if it's a systemic response, then why is it not a bilateral swelling, instead of just on one side? If a biopsy is conducted on the mass - presumably a lymph node, per the reasoning above - would that indicate what kind of cancer it is, or would it merely tell us that it's some kind of cancer and that would be a prelude to a hunting expedition to find where the cancer may be in the body.
As a result of this non-veterinary speculation, our first instinct is to wait on the biopsy - because come Friday, it would be only 1 week from the start of the swelling - until the antibiotics have a chance to work... a full course would be something like 10 days. Also, push to find some non-highly invasive way to try to ascertain if it's indeed a tooth abscess (X-ray?). If we eliminate the possibility of a tooth abscess, and the antibiotics don't work within 10-14 days, perhaps only then put him under for a biopsy? However again, what does a biopsy give us here?