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Old July 7th, 2007, 05:46 PM
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vaccine lump persists - Answered by Dr. Lee

I posted a few months ago about our middle-aged kitty having a bad reaction to a vaccine (Feline Leukemia vaccine on her left flank). Well, nearly three months later, the lump persists. I don't think it's gotten any bigger, it actually went down within the first month of it being there... but the fact remains it is STILL there! It's not well-defined, it's not firm, it's less than the size of an olive (or maybe about that size, just kind of elongated)... I notice it when petting her... but it's not going away. Everything I read says VAS but one site said that "persistant vaccine reactions must be eliminated as a cause". Could it just be a benign persistant "thing"?? Obviously, we will be calling the Vet come Monday!

Last edited by LittleMomma; July 7th, 2007 at 05:50 PM.
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Old July 7th, 2007, 06:03 PM
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I have never had this happen with either of my cats <insert "touch wood" smiley here>. I know one of Chico's cats had this problem but don't know how long the lump lasted.

Geeze, I'm not much help here, am I?

But, Dr. Lee has been really generous with his time here lately and I'm sure he will answer next time he logs on.
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Old July 7th, 2007, 07:27 PM
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Rainbow,

Thanks for the vote of confidence!!!



Little Momma,

Persistent vaccine lumps in cats after a FeLV vaccine can be of concern and definitely indicates a trip to the veterinarian. Some can be benign but there is concern that most of the FeLV vaccines may in some cause an aggressive soft tissue sarcoma (cancer) in some cats. There is different numbers on the rate of vaccine induced cancer but there was a lecture in 2006 by a veterinary oncologist Dr. Rassnick that stated the annual occurence in the USA was, "at a rate of 0.63 to 3 per 10,000 cats vaccinated annually." Some vaccine representatives still even say that the vaccine hasn't been linked to the cancer - but that is not the general impression.

Currently there are non-adjuvanted FeLV vaccines which reduce the risk and a recombinant, non-adjuvanted, needless vaccine which to date, has not ever been shown to have caused cancer. (it is the Vet Jet system by Merial and looks like a white and teal colored space pen). Note: different veterinarians choose different vaccines. There is a lot of controversy out there. Overall the risk is low, but when it is your cat that doesn't necessarily make you feel better!

What to do now?
1) Relax. While the risk is present, it is low. Before I switched to the Vet Jet, I had been injecting FeLV vaccines for 8 years and never had a sarcoma come back. I had a collegue that I worked with have one (that was in a 6 doctor practice).
2) Bring him to your veterinarian and discuss the situation. Ask her/him whether fine needle aspiration, biopsy, surgical excision with biopsy or waiting/antibiotic therapy is the best for your cat.

Good luck and keep us updated.
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Old July 7th, 2007, 09:28 PM
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Thank you! Could it still be a granuloma of some sort?
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Old July 8th, 2007, 12:37 AM
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Yes. A granuloma is a mass compiled of inflammatory cells. If the vaccine lead to local inflammation (which is what non-adjuvanted and recombinant, non-adjuvantted try to avoid/minimize) then granulomas are the most common cause of lumps. Where the concern for cancer comes in, is that the inflammation triggers off tumor growth. Again the odds are generally much more favorable to a benign mass however with the chronicity of this, we need to find out.

Good luck and best wishes. Keep us posted.
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Old July 8th, 2007, 10:02 AM
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Thanks a million, Dr. Lee! In certain positions, you can barely notice it which leads me to believe it is not firm - to me, it feels more squishy, like I can pinch it between my fingers and it almost feels like fatty skin (though I know it's not b/c of the location of it - right at the FeLV vacc site). Poor baby, I've been poking and prodding her all night which I think may have caused the area to swell and feel bigger to the touch. I'm a paranoid cat momma! I did not know how long a granuloma could stick around for. Should I request a fine needle aspirate? If it comes back as non-cancerous at this stage, what should my next course of action be? I've read the horror stories of excisions causing any cancer to metastasize, but is the same true if a benign mass (inflammation, etc) is excised? Sorry for so many questions, trying to ease my mind!
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Old July 8th, 2007, 12:23 PM
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You have great questions.

My recommendation is fine needle aspiration (FNA). In general if surgery is to be performed on a STS (soft tissue sarcoma) it is preferable to know BEFORE surgery. Therefore FNA is a good choice. Hopefully a benign inflammation will be found.

How long can granulomas hang around?
It can be a long time. Some granulomas turn into scar tissue so it is hard to give it a time line. Warm compressing can help resolve granulomas. The warm compressed increase blood flow to the area.

Risks of metastasis following surgery...
These risks also follow FNA. Unfortunately there is always risks. Why is there risk of metastasis? Any inflammation of cancer cells can cause them to metastasize. This is why FNA is a good choice - less inflammation and if a STS is present then very AGGRESSIVE margins can be made in the hope that no cancer cells are left in the wake of post surgical inflammation. This is also an advantage of lasers employed in surgery - they can ablate and destroy the cells at the incision site while at the same time minimize both pain and inflammation.
Note: benign masses can NOT metastasize. Metastasis is a characteristic of the malignant.

Hope that helps.
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Old July 8th, 2007, 05:01 PM
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Very helpful. One last thing, if I may: I have read that most vaccine associated sarcomas are indeed firm. Would it feel like a solid lump? Hers does not feel solid to me but rather a swelling. Oh, also!.... when this lump first appeared, about two weeks after the vaccination, our former vet (we have since moved, unfortunately) injected an antibiotic combo underneath the lump which seemed to help it... I'm confused as to how this helped but did not cause the lump to completely disappear.
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Old July 8th, 2007, 06:41 PM
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Yes generally they are firm and again the statistics are in her favor. It sounds like you will feel much better once it has been tested though.

The only reason I can think of injecting an antibiotic at the site is to address a possible infection. One note: any inflammation can lead to STS. There is thought that this would include other injections, trauma, bug bites, excess heat or cold, etc.... So additional injections are may help or could theoretically increase inflammation. You said a combo - were there steroids in there to reduce inflammation? Or more than one antibiotic?
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Old July 8th, 2007, 07:10 PM
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Truth be told, I don't know what was in the injection other than the antibiotic. The invoice said "combo inj". I have read about the link between inflammation and oncogenesis... that's why I'm so darn scared!!

If the FNA comes back as benign (praying!!) should I push to have the lump removed or is that even possible if it is indeed inflammation being that it is not hard and solid?

She had a firm subcutaneous lump underneath her chin (right at the apex of her mandible) a few weeks ago that we almost biopsied but a steroid shot cleared it right up within a few days and it hasn't returned. During the same time she also had what was believed to be an allergic rxn on the insides of her hind legs (scabby sore-looking things) which also cleared up after one shot of steroids (0.75 of the usual dose since she is a hefty cat). I'm hoping that ocurrance - the chin lump - is NOT related. Never found out what it was, attempted a FNA but she would not cooperate so they booked the biopsy, but as I said, it cleared up before then - as in completely gone - so there was nothing left to biopsy and it has not returned.

You are SO right that I will be immensely better when I know what is going on! I deal with the human condition and I will be the first to admit that I haven't near the emotional wherewithal to deal with animals for a career, as much as I love them.
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Old July 9th, 2007, 07:42 AM
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Made an appt but since there are three docs out in the practice, it's not til Thursday Should I try to book an emergency appt or can it wait?
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Old July 9th, 2007, 02:06 PM
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I know that you want to find out as soon as possible but waiting till Thursday in order to work with the same veterinarian that you are familiar with and is familiar with the case is not going to change the result of the FNA. I think you are doing the best for your pet and with the history and statistics, likely everything is fine. So keep your appointment and try to keep your mind off of it.

Good luck
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Old July 9th, 2007, 02:44 PM
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Wow this post has been great and so informative thank you both LittleMomma and Dr. Lee, Fagan got his latest Depomedrol shot about 2.5 weeks ago and his lump appeared about a week ago. He has had this two times before after his shots and the lumps usually take 2-3 weeks to fully disappear. I use traumeel drops in water to help speed the healing (both for the lump and the skin issue he gets the shots for, as well as his reoccurring knee injury brought on by the shots). I will maybe try the warm compress as well to see if that helps. The lumps never bother him, so I just keep an eye on them and track their progress.

Thanks for all the info.
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Old July 9th, 2007, 04:12 PM
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I remember reading about Fagan's lumps... does his keep reaccuring, is that what the shots are for? The lump doesn't bother out cat, either... except for me poking and prodding it. I had our other cat in today for a URI (they'd see her b/c she was sick but had me wait for an appt for the other one) and I asked her her thoughts on it and she said that since it has been sticking around its important to get her in to be felt but since she developed a bump after the rabies, also, she is obviously prone to reaction. Too bad I can't see her - I was very impressed with her but she's only there Monday mornings Anyway, these are new vets for us since we moved, but the one she has the appt with on Thurs owns the practice and came highly recommended by a family friend who has a LOT of critters, so I feel comfortable in him seeing her. Now, if only I could relax til then!
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Old July 9th, 2007, 04:20 PM
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My Vinnie got his lump about one week afters his vacs,but it was an oblong lump about 8cm long,very squishy.
Worried,I took him to the vet,she said it's a VERY uncommon reaction to the vacs,but I found out here on the Forum,it is not that uncommon.
He had his lump for about 3 weeks and now it's totally gone.
Thank's Dr Lee for giving us all the info
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Old July 9th, 2007, 05:14 PM
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Oh ... um , no the shots are depomedrol (a steroid) for an allergic skin reaction, he has never had a shot to get rid of the bumps. He gets the lumps after just about every shot now, no matter what the shot is of. It is usually just a small ball like lump that disappears within a month. I think this is the third or fourth time it's happened. The first time I had the vet check it right away, she said it was nothing to worry about and just to be patient as they sometimes take quite a while to disappear. And if it ever doesn't disappear I'll march him right back to the vets to investigate.
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Old July 9th, 2007, 06:01 PM
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Oh I see, I misread. I guess some cats are just more prone to reactions than others, huh? The vet today (who saw our other cat but I asked about this lump) said that it's good that it's soft but they need to make sure its not attached underneath. Said usually with the sarcomas they will attach to muscle. So of course now I'm driving her batty trying to determine whether or not it's attached! She's a hefty kitty so it's hard to tell when exactly I'm feeling. Guess I should leave it up to the experts!
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Old July 9th, 2007, 06:30 PM
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I have been following this thread with all it's great information and will bookmark it in case I ever have this problem.

Little Momma, I hope your kitty is okay and good luck at the vet. And, thanks for posting your questions and Dr. Lee, thank you for your informative answers.
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Old July 9th, 2007, 10:55 PM
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Maybe we should sticky this post or something for future reference.
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Old July 10th, 2007, 12:00 AM
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Some additional thoughts...

I wanted to make sure that this and other threads does not discourage people from obtaining FeLV and rabies vaccines for their cats, if their age and lifestyles require it.

Especially with the advent of the Vet Jet system for FeLV and recombinant technology in general. To date, the Merial recombinant FeLV (Vet Jet) and recombinant rabies vaccines have not been linked to STS formation in cats. The reason for the Vet Jet is that not only does it have recombinant technology but it used an air delivery system which utilizes only 0.255cc of vaccine. Instead of pooling 1cc of vaccine under the skin, the needles injection spreads the 0.25 cc of vaccine in an even distribution which virtually eliminates pooling, a cause of inflammation.

What is recombinant technology? Only the portion of the virus that the body recognized is used. It placed these with a harmless canary virus instead of using a modified dog or cat virus. No possibility of reversion (to the actual disease), greater immunity response in most cases, less anaphylaxis reactions and no documented immune suppression.

So there are some great options for cats who need FeLV and Rabies. Who needs it? Depends on who you ask. When you have some very safe options available, the vaccine can be given with less concern.

Do I have stock in Merial? No. I just really like there vaccines. (I better, since they cost more than any other vaccine I have found yet). Since my vaccine charges are equivalent to many vets around me, we just have lower profit. No biggie - we feel comfortable administering them. I have some technicians who were not vaccinating their pets for these diseases until they started working here where these are available.

Is there controversy? Some - none that say that the recombinant/Vet Jet has any risks - just some controversy that either the other vaccines don't cause the problems or that the Vet Jet hasn't yet been out long enough to know. What is the answer? I don't know but I feel that these are the most safe vaccines to our knowledge to date for cats needing FeLV and rabies. Tomorrow it may change, and I will try to remember to post it here when I learn about it!
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Old July 11th, 2007, 09:15 AM
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Dr. Lee, speaking of these vaccines, what is your opinion on not vaccinating every year for a cat that is strictly indoors. With six we are opting to go every other year for the vaccines (I'm just wondering if this is ok- all of my cats are 5 yrs or younger and the vaccines cost us just over $600). My vet doesn't seem to think it'll be a problem, but I'd love another opinion. How long do the vaccines protect them for?
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Old July 12th, 2007, 10:04 AM
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***UPDATE*** Well, today was the vet appt. I'm not sure how to feel about it. The good news is that upon feeling the lump, he said it does not feel like a sarcoma. However, the concern is the way they start. He said to give it six more weeks and if it doesn't go down, to remove and biopsy, but at this point he doesn't see a reason for it. He said the fact that she had injections beneath the lump initially (the antibiotic combo inj) could still be causing the swelling since there were multiple injections given in that spot. But for now, it's not a sarcoma. He said if it developed into one it would feel drastically different to him (not sure if it would to me, but to him it would be fairly a obvious change). He had me call our old vet to get the name and manufacturer of the vaccine given. It was Pfizer Leukocell 2. He said he's going to call the company and I am to call him back tonight to see what he's found out but that it's a good thing that they are such a major company.
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Old July 12th, 2007, 10:14 AM
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krdahmer,

I think going every other year for vaccinations on an indoor cat is fine. I have some clients that do it every three years. If they are 10 or older, a think yearly physical examinations and routine blood work is more important.

There is a lot of controversy over vaccinations and as time goes by and more information (credible, properly controlled studies, etc..) is available, I believe we are going to see a wider and wider gap in frequency on viral vaccinations. I think age, breed, health status, lifestyle and demographics need to be strongly considered when making the decision on which vaccines to use, how often to give and if the vaccines are even needed at all. Unfortunately because of the wide variability it is hard to give easy answers; but for older, indoor cats, vaccines every other year does sound just fine.
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Old July 13th, 2007, 10:35 AM
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Got a call back from the vet this morning. He called Pfizer to ask about specific numbers and statistics for the Leukocell 2 vaccine. He said their incidence of fibrosarcoma are lower than a lot of other brands and that it's a good vaccine, so we'll sit on it for a while. Yesterday he said to wait six weeks, but then on the phone today he said, "I know you're really beside yourself about this... let's give it four weeks". So if it doesn't go down in four weeks, we will remove it. But again, at this time it doesn't feel like a sarcoma (have to keep reminding myself of that!)
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Old July 13th, 2007, 03:47 PM
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Littlemomma,don't worry,I am sure it will go away,my Vinnies lump was huge and liquidy,my vet said she would take a biopsy if it did not go away,that alone sounds scary.
I just read back a bit and you tell us your kitty has had the lump for months,that's a bit different from my cat,who had his lump for a couple of weeks after his vacs.
Still,don't worry too much,a lump can mean sooo many things,not always the big scary C-Word.
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Old July 13th, 2007, 04:01 PM
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Yes, he said it doesn't feel like a sarcoma at this point. He said it would feel different to him. I asked him this morning what I should look out for and he said, "don't look for anything b/c if you go looking for something you'll find it!!.... unless it changes drastically, we'll take it out in 4 wks". This guy's got my number already... I'm such a paranoid kitty momma!! It sounds like he thinks she'll be ok, but when it's your kitty, it's VERY scary!!! So I'm just gently running my hand over the area, like I'm petting her, to make sure it's not changing. I think I might bring her in in two weeks just so he can check it, too.
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Old July 13th, 2007, 04:14 PM
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We are all worry-warts with our animals,I check my 3 cats every day,often follow them to the litter-boxes making sure they are peeing and pooping ok just a little paranoid it comes with loving them an awful lot
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Old July 14th, 2007, 08:06 AM
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LittleMomma, you just hang tough!

You know what I'd do? I'd leave it absolutely alone for 2 weeks, then do my nervous heart a favor and bring her in to have the vet check it. Just don't even touch her there. We have the tendency here to overreact and check it all the time, manipulate it, roll it...and all that touching irritates it and (yep...you guessed it ) makes it bigger! he he We're also very paranoid pet parents, can you tell?!

So now, we try not to mess with lumps at all and let the vet feel it again in a few weeks. The vet gets a better picture of what's going on that way. Then, if in 4 weeks, it still hasn't gone down, at least we know it's not a false alarm from us irritating it.

As scary as they are, we've learned to just wait on lumps. We had one lump on Cass that came up so fast and hard, two weeks after vaccination, that the vet thought it might have been a mast cell tumor. We had it taken off, and just in case it was a MCT, the vet took out a lot of margin tissue, too. Poor Cass had a drain and was miserable for a week afterward--we were pretty traumatized, too... And when the biopsy came back? Turned out to be a vaccination reaction after all If we'd waited, it likely would have resolved by itself.

So now we always wait if it's anywhere near a recent (within a month) vaccination site. It can be scary, though... Very nerve-wracking!

s, s, s, and 28 crossed s that the lump goes down and your worry evaporates!
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Old July 18th, 2007, 08:22 PM
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Just wanted to update. She will be having surgery on Tuesday to remove and biopsy the lump. I ended up bringing her back in tonight because I just can't stand it being there, wondering what the ^%# it is!! When I felt it earlier it felt like a piece was attached underneath, I totally freaked out and took her in.

The vet (different vet this time b/c of the short notice of the appt) said it didn't really feel like a sarcoma but again, the only way to find out is to biopsy it. So we set up the appt for Tues. I asked her how worried she's be (I was in tears at this point) and she said she wouldn't be running out of the room but she'd be suspicious. She also said that the inflammation could make it feel like it's attached. So that's that.

Please pray for her. I'm immensely worried (and being 8 months pregnant doesn't help matters at all!) She is part of our family and we love her more than words can possibly say.

I'm going to make sure they do pre-op bloodwork because she is a 17 lb cat (she should be around 12) and she's a bit older. After they send the sample to the lab it takes about 7-10 days to get the results. I'm not looking forward to that wait but I'm praying they will be good results!
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Old July 18th, 2007, 08:42 PM
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The waiting is always the worst...but now you'll know for sure!

Meanwhile, though, s, s, lots of s and 28 crossed s sending good wishes your way from Hazel Run!
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