Hemangiosarcoma

[Guest Fasave]

Two days ago, I took Avalanche to the e-vets. I accidentally posted this topic in EEG. The short version is that after abdominal x-rays, they found fluid, which turned out to be bloody but not fully blood. They did an ultra sound and saw something either on his liver or spleen or both but more prominent on liver. They did a u/s guide needle biopsy and the results were inconclusive. All signs pointing to hemangiosarcoma. Surgery is the only was to confirm but even with surgery survival times are short. The vet shared the 50% of tumors in this area are hemangio IF they haven't bled. If they've bled, the chances increases to 85%. The oncologist who is/was treating Ave for short tissue sarcoma in his leg, confirmed these stats and given that Ave has cancer in another area and all his known littermates have died from suspected various forms of cancer, the odds get even worse. So, I spent yesterday preparing to let him go.

 

I found a local vet clinic that was open until 8 and the vet was willing to come to the car. No appointment necessary. Ave hadn't eaten and drank much, hadn't gone out since very early morning, and spent the day just curled up on the couch with me. At 6:30, I warmed up the car, got him up and walked him outside into the yard. He did a pee and poo and then went back onto the deck and wanted to go inside. He then went to his food dish and he actually ate a can of food. He then went to the bottom of the stairs and looked at me like "isn't it time for bed?". So, I said okay figuring if things turned during the night, I was within 20 minutes of several 24 hour e-vets.

 

We both got some good sleep overnight and I was surprised when I got up, he did as well, greeting me with a wagging tail. He went outside, did a pee and a poo, came inside and asked for a treat and curled up on the couch. I took my other grey for a walk and when I came home and began preparing Thunder's breakfast, Ave appeared in the kitchen looking for breakfast as well. The day has been pretty boring. He's been engaged, nudging me for ear scritches, going out and taking care of business, asking for treats and wagging his tail. Except for appearing a little more tired than normal(and he's taking tramadol), it's like nothing is wrong with him.

 

Is this typical? Did he just have a small bleed which stopped and now the fluid is gone from his abdomen so he's feeling better? While I'm glad he talked me out of what was suppose to be his final journey last night, I'm now wondering if this will be a roller coaster for a while. Anyone with experience who has chosen not to do the surgery route? Insights would be appreciated.

[tbhounds]

Gonna be a rollercoaster ride if you don't do the surgery. He may continue to have bleeding episodes and and when they clot and the blood reabsorbs he'll feel better. there may be a time were the bleed will be a one way road for him. Surgery will not be easy if the liver is involved. A splenectomy would be more routine but, a diseased liver is a different case. I truly would only let the best of the best perform the surgery (like Ohio State) because of the possible surgical complcations. You might want to contact GT member packmom as her girl had something similar ( she had the surgery at OSU). Sorry you are presented with such a decision--I know it's not easy trying to do what's best for our pups.

[kudzu]

First, what I am about to say does not mean Avalanche's symptoms are from hemangiosarcoma. Am just answering your question honestly. Yes, it sounds similar to my experience with hemangio in my Spaniel mix. The necropsy confirmed hemangio of the spleen & it had already metastasized. It also reminds me of a less severe version of what happened to my 13 yo senior at the end though I did not have a necropsy done to confirm what the actual cause of his collapse was. He had had chronic lymphocytic leukemia for years so some rapid onset, overwhelming, systemic infection was a possibility but his presentation & lab work was consistent with hemangio. In neither case was I really given an option of surgery. Their condition was so severe & devastating that heroic efforts seemed cruel.

 

Would I have chosen surgery had I known a little sooner, before a massive bleed? Certainly not for my senior at his age, with his history. For my then approx. 10 yo Spaniel? Given the benefit of hindsight I will say no. However, I would not have had the benefit of hindsight. She acted more like a 5-6 yo. Probably not but because the odds were poor... How could I say for sure though?

 

Again, this does not mean what you describe is the result of hemangio. Those symptoms cross over too many other illnesses. I wish the best for you both. It is a terribly difficult to be in. You will be in my thoughts & I hope very much he stays hungry & comfortable for a long time to come.

 

ETA: I don't want to say this but I think I should. This of course is very personal so remember I am writing it from my point of view. Have lost three dogs in emergency situations, at least one & possibly two to hemangio. I need to say that the preplanned release of my other dogs was a far preferable ending for me. It allowed me to give them a calm, peaceful departure surrounded by those who loved them. It was painful & there were still some what ifs but nothing like how I felt after the emergency losses. That's me. Others have different feelings, beliefs & past experience that would effect such decisions.

Edited December 3, 2010 by kudzu

[Guest Fasave]

Thank you. I needed to hear honesty. You see a day like today and you start to believe everyone got it wrong but I re-read all the information on hemangio and it's consistent. I have already decided that surgery is out. Ave is a very high stress grey and even the hospitalization would be too hard on him, let alone the surgery, for the time he would have in the end. He would turn 11 next Friday. Sadly, without surgery, I'm not able to get confirmation. I also very much appreciate the advise of a planned euthanasia. It's hard to hear but definitely makes some sense as well.

 

Thank you.

[Batmom]

Can't offer advice, just hugs.

[Guest Stripeyfan]

No advice here either, but thinking of you and your boy - sorry he (and you) are having such a rough time.

[Guest greytbookert]

Wow, that is a roller coaster of a day! I'm sorry!

 

I don't have too much in the way of advice, since it was never confirmed just strongly suspected that T had hemangio.

 

I won't go into the details but T went quick and under emergency care. If you need anything, let me know. I'll be thinking of you and Ave!

[Guest KennelMom]

Is this typical? Did he just have a small bleed which stopped and now the fluid is gone from his abdomen so he's feeling better? While I'm glad he talked me out of what was suppose to be his final journey last night, I'm now wondering if this will be a roller coaster for a while. Anyone with experience who has chosen not to do the surgery route? Insights would be appreciated.

 

This is what would happen as described to me by Haley's vets that diagnosed her with hemangio (an e-vet and a board certified specialist that was paged to do the u/s). When the tumor bleeds, they feel like crap and won't want to eat or do much. The bleeding stops, the body re-absorbs the fluid and the dog feels better and acts normally. When there starts to be more bad days than good is when it's time to say goodbye. They gave me the impression I had days or a week, but we're several weeks out and she's still having mostly all good days.

 

sending hugs to you and Ave...

Edited December 3, 2010 by KennelMom

[Guest GreysAndMoreGreys]

My angel girl Weenie went along the same route as your hound.

We noticed she was off a bit on eating and started getting fluid build-up.

Did the whole set of stuff you did including the needle biopsy with the same results.

 

With Weenie, we chose to go with some lasix and pred. Lasix for the fluid that was building and pred to help reduce the swelling.

We had a good month after that. I had my Weenie back during that time.

What caused us to make the decision to say goodbye yo Weenie was having problems getting comfortable.

I assume the tumors were growing and causing breathing and comfort issues for her to lay down.

 

[Guest Fasave]

This is what I suspected although it was nice for about an hour last night when I convinced myself that everyone was wrong. He's good this morning and wanted breakfast but did not finish. He is basically with me 24/7 and has been for the last two years so I'm very aware of even small changes. Even still, I'm wondering if this was his first bleed or if I've missed others. As of Tuesday, his lungs were still clear and they checked is clotting factors prior to the FNA which were good. My big fear is the "big bleed" and having him go through unnecessary pain. So for now we just go hour by hour with lots of cuddles and stritches. Thanks everyone for your insights. It helps to know what to expect.

 

Is this typical? Did he just have a small bleed which stopped and now the fluid is gone from his abdomen so he's feeling better? While I'm glad he talked me out of what was suppose to be his final journey last night, I'm now wondering if this will be a roller coaster for a while. Anyone with experience who has chosen not to do the surgery route? Insights would be appreciated.

 

This is what would happen as described to me by Haley's vets that diagnosed her with hemangio (an e-vet and a board certified specialist that was paged to do the u/s). When the tumor bleeds, they feel like crap and won't want to eat or do much. The bleeding stops, the body re-absorbs the fluid and the dog feels better and acts normally. When there starts to be more bad days than good is when it's time to say goodbye. They gave me the impression I had days or a week, but we're several weeks out and she's still having mostly all good days.

 

sending hugs to you and Ave...

 

 

Thank you and very sorry about Haley. Hemangio sucks. I hope you continue to have more good days wih her.

[Guest lizmego]

I guess our story is a bit different. We took Dell, greyhound, age 12, into regular vet because he wasn't maneuvering stairs well and thought he had arthritic issues. Vet checked him over and determined through palpatation that his spleen was enlarged and he had a mass of fluid in his abodomen. We were sent to speciality clinc for an ultrasound. Ultrasound showed the fluid mass blocking a lot of the organs, but liver appeared good. They recommended surgery. Didn't offer a needle biopsy. So the next day Dell has surgery - a splenctomy and they sent off the fluid filled mass (cantelope sized tumor, it weighed 6 pounds) to a lab. I should add that xrays of his lungs were taken prior to surgery and his lungs did not have any suspcious masses or lesions, so surgery was done (additionally, he had just had a wellness check in July and he did not have a mass and his weight showed him 6 pounds lighter - so the mass grew in 4 months time - all the vets think we were lucky in finding it early). From what I understand of the pathology report, there were suspicious cells in the tumor and spleen but not on the liver, and he was NOT diagnosed with Hermangisarcoma (malignant) but with hermangioma (benign). His surgery was on November 10. He's all healed now, altough currently treating for a urinary tract infection and I need him to gain more weight (he's never held onto weight very well) the surgery and his lack of appetite immmediately after surgery didn't help him keep the weight that he had. I'll add that Dell is a spook and quite sensitive, he didn't handle being at the vet hospital overnight in ICU very well, but we knew it was for the best and he was hopped up on pain meds most of the time. But he recovered really well.

 

The surgery was expensive ($3,000),this cost included the ultrasound, meds and xrays. The surgeon said the surgery was really easy. Only took 1 hour when they allotted for 2 hours (so we're guessing that's why the cost wasn't more, they had originally quoted us $3,000 for only the surgery - we were expecting a bill of about $3,500). If Dell's lung xrays would have come back with suspicous areas, we would not have done surgery and would have just pampered and spoiled him until he needed to pass on.

 

In all honesty, and I don't say this to scare you, but my main concern with the fluid filled mass was the not knowing the time or place that it could rupture. If it ruptured while we were at work, not knowing what kind of pain is involved with a rupture, we just weren't willing to take that chance.

 

ETA: Another reason we chose surgery was that Dell's bloodwork was really good and the vets remarked how you wouldn't know that Dell was 12, you'd think based on his health, bloodwork and overall appearance, that he was a younger dog. So we determined that he could handle the surgery.

 

ETA2: sorry, another add....we don't think dell's tumor ever bled. He never showed signs of being ill. Just couldn't manuver stairs, which we took for hip/arthritic issues.

Edited December 3, 2010 by lizmego

[carronstar]

No advice, just good thoughts and prayers.

[TheFullHouse]

This is what we went through with our pup, not knowing it at the time. DeeYoGee was attached to Mike at the hip and the first episode he had was when Mike went home to see his father for two weeks. The second week our guy wouldn't eat and just lay around, this was his usual behavior when Mike went away so I didn't think anything of it. Mike came back and he perked up again, all was well, or so I thought. Mike ended up going back because his father was so ill two weeks later and after he left DeeYoGee did it again so again I thought it was just Mike being gone. This time when Mike came home DeeYoGee didn't perk up and that night went off into the spare bedroom where he never went. I went to get him and saw his gums were almost white. He was having a major bleed. It was off to the e-vet and his stomach was full of blood. They could do emergency surgery on him and remove the spleen but the damage was already done. The vet told us with the bleeding, cancer cells are being reabsorbed into the body. We chose to let our boy go that night because the prognosis was so grim.

 

I'm so sorry you're going through this. I hope you have many more good days with your sweetie.

[Guest Fasave]

I guess our story is a bit different. We took Dell, greyhound, age 12, into regular vet because he wasn't maneuvering stairs well and thought he had arthritic issues. Vet checked him over and determined through palpatation that his spleen was enlarged and he had a mass of fluid in his abodomen. We were sent to speciality clinc for an ultrasound. Ultrasound showed the fluid mass blocking a lot of the organs, but liver appeared good. They recommended surgery. Didn't offer a needle biopsy. So the next day Dell has surgery - a splenctomy and they sent off the fluid filled mass (cantelope sized tumor, it weighed 6 pounds) to a lab. I should add that xrays of his lungs were taken prior to surgery and his lungs did not have any suspcious masses or lesions, so surgery was done (additionally, he had just had a wellness check in July and he did not have a mass and his weight showed him 6 pounds lighter - so the mass grew in 4 months time - all the vets think we were lucky in finding it early). From what I understand of the pathology report, there were suspicious cells in the tumor and spleen but not on the liver, and he was NOT diagnosed with Hermangisarcoma (malignant) but with hermangioma (benign). His surgery was on November 10. He's all healed now, altough currently treating for a urinary tract infection and I need him to gain more weight (he's never held onto weight very well) the surgery and his lack of appetite immmediately after surgery didn't help him keep the weight that he had. I'll add that Dell is a spook and quite sensitive, he didn't handle being at the vet hospital overnight in ICU very well, but we knew it was for the best and he was hopped up on pain meds most of the time. But he recovered really well.

 

The surgery was expensive ($3,000),this cost included the ultrasound, meds and xrays. The surgeon said the surgery was really easy. Only took 1 hour when they allotted for 2 hours (so we're guessing that's why the cost wasn't more, they had originally quoted us $3,000 for only the surgery - we were expecting a bill of about $3,500). If Dell's lung xrays would have come back with suspicous areas, we would not have done surgery and would have just pampered and spoiled him until he needed to pass on.

 

In all honesty, and I don't say this to scare you, but my main concern with the fluid filled mass was the not knowing the time or place that it could rupture. If it ruptured while we were at work, not knowing what kind of pain is involved with a rupture, we just weren't willing to take that chance.

 

ETA: Another reason we chose surgery was that Dell's bloodwork was really good and the vets remarked how you wouldn't know that Dell was 12, you'd think based on his health, bloodwork and overall appearance, that he was a younger dog. So we determined that he could handle the surgery.

 

ETA2: sorry, another add....we don't think dell's tumor ever bled. He never showed signs of being ill. Just couldn't manuver stairs, which we took for hip/arthritic issues.

 

Thanks for sharing your story. There are a few differences I see in that there has been a bleed and I've been told this increases the likely hood of the tumor being cancerous. In addition, his liver is likely involved, he has had two previous cancers (soft tissue leg, nerve sheath on back) and all his known littermates have passed from a cancer related illness. I know it sounds like I'm rationalizing my decision, and I guess I am, but it really DOES help to hear the other stories and how they are similar and different. I guess I'm just thinking out loud...

 

This is what we went through with our pup, not knowing it at the time. DeeYoGee was attached to Mike at the hip and the first episode he had was when Mike went home to see his father for two weeks. The second week our guy wouldn't eat and just lay around, this was his usual behavior when Mike went away so I didn't think anything of it. Mike came back and he perked up again, all was well, or so I thought. Mike ended up going back because his father was so ill two weeks later and after he left DeeYoGee did it again so again I thought it was just Mike being gone. This time when Mike came home DeeYoGee didn't perk up and that night went off into the spare bedroom where he never went. I went to get him and saw his gums were almost white. He was having a major bleed. It was off to the e-vet and his stomach was full of blood. They could do emergency surgery on him and remove the spleen but the damage was already done. The vet told us with the bleeding, cancer cells are being reabsorbed into the body. We chose to let our boy go that night because the prognosis was so grim.

 

I'm so sorry you're going through this. I hope you have many more good days with your sweetie.

 

I am sorry for your loss. I am lucky that I have the luxury of being with him pretty much 24/7 at this time. He even sleeps in my bed so I can keep a close eye on him at night. In the past when he hasn't felt well, he won't let me touch him. That will likely be my first clue. Fortunately I'm in Boston with lots of resources to be able to let him go quickly. I really hope he lets me know before things get too uncomfortable.

[Guest MorganKonaAlex]

I hope I don't add to your internal debate but let me tell Kona's story. She was having visible blood in her urine despite several treatments with anti-biotics. An ultra-sound found a mass in her kidney. We couldn't do a needle aspiration because of it's proximity to the renal artery. We were told the most likely cause of the mass was hemangiosarcoma. We did the surgery to remove the kidney. It turned out not to be a tumor at all. Her kidney had an infarction which caused the mass. No tumor, no cancer.

 

I'm more cautious now about making end of life decisions based on an unconfirmed diagnosis.

[Guest LindsaySF]

I'm sorry to hear this. The good thing is you know what you're dealing with, and you are with your dogs all the time so you can pick up on small changes. My advice would be that you know Ave's personality, you can tell when he's not himself. If he's not himself for more than a day, I would consider letting him go, before he's really uncomfortable or in pain.

 

We lost our 13 year old Chow to suspected hemangio. He was older with arthritis, not getting around too great anyway. His appetite started getting poor, he would only eat chicken & rice, no kibble. He had good days and bad days, which we attributed to old age. One morning he wouldn't get up, and he was panting pretty heavily. We gave him some time, but he didn't get better later that day, and he even refused his chicken & rice. He was panting really hard at this point, so we rushed him to the vet. (We couldn't check his gums for paleness because Chow gums and lips are black). She palpated him and felt fluid in his abdomen, she suspected a tumor had ruptured and there was nothing to be done. We let him go.

 

In hindsight, I felt we let him go a little too late. We should have let him go on one of his good days, not a bad day. Signs that we attributed to "old age" were probably the tumor growing. I've heard the saying "Better a day too early than a day too late". I have to say I agree with that.

 

Good luck in your decision.

 

 

 

~Lindsay~

[Guest lizmego]

I guess our story is a bit different. We took Dell, greyhound, age 12, into regular vet because he wasn't maneuvering stairs well and thought he had arthritic issues. Vet checked him over and determined through palpatation that his spleen was enlarged and he had a mass of fluid in his abodomen. We were sent to speciality clinc for an ultrasound. Ultrasound showed the fluid mass blocking a lot of the organs, but liver appeared good. They recommended surgery. Didn't offer a needle biopsy. So the next day Dell has surgery - a splenctomy and they sent off the fluid filled mass (cantelope sized tumor, it weighed 6 pounds) to a lab. I should add that xrays of his lungs were taken prior to surgery and his lungs did not have any suspcious masses or lesions, so surgery was done (additionally, he had just had a wellness check in July and he did not have a mass and his weight showed him 6 pounds lighter - so the mass grew in 4 months time - all the vets think we were lucky in finding it early). From what I understand of the pathology report, there were suspicious cells in the tumor and spleen but not on the liver, and he was NOT diagnosed with Hermangisarcoma (malignant) but with hermangioma (benign). His surgery was on November 10. He's all healed now, altough currently treating for a urinary tract infection and I need him to gain more weight (he's never held onto weight very well) the surgery and his lack of appetite immmediately after surgery didn't help him keep the weight that he had. I'll add that Dell is a spook and quite sensitive, he didn't handle being at the vet hospital overnight in ICU very well, but we knew it was for the best and he was hopped up on pain meds most of the time. But he recovered really well.

 

The surgery was expensive ($3,000),this cost included the ultrasound, meds and xrays. The surgeon said the surgery was really easy. Only took 1 hour when they allotted for 2 hours (so we're guessing that's why the cost wasn't more, they had originally quoted us $3,000 for only the surgery - we were expecting a bill of about $3,500). If Dell's lung xrays would have come back with suspicous areas, we would not have done surgery and would have just pampered and spoiled him until he needed to pass on.

 

In all honesty, and I don't say this to scare you, but my main concern with the fluid filled mass was the not knowing the time or place that it could rupture. If it ruptured while we were at work, not knowing what kind of pain is involved with a rupture, we just weren't willing to take that chance.

 

ETA: Another reason we chose surgery was that Dell's bloodwork was really good and the vets remarked how you wouldn't know that Dell was 12, you'd think based on his health, bloodwork and overall appearance, that he was a younger dog. So we determined that he could handle the surgery.

 

ETA2: sorry, another add....we don't think dell's tumor ever bled. He never showed signs of being ill. Just couldn't manuver stairs, which we took for hip/arthritic issues.

 

Thanks for sharing your story. There are a few differences I see in that there has been a bleed and I've been told this increases the likely hood of the tumor being cancerous. In addition, his liver is likely involved, he has had two previous cancers (soft tissue leg, nerve sheath on back) and all his known littermates have passed from a cancer related illness. I know it sounds like I'm rationalizing my decision, and I guess I am, but it really DOES help to hear the other stories and how they are similar and different. I guess I'm just thinking out loud...

 

This is what we went through with our pup, not knowing it at the time. DeeYoGee was attached to Mike at the hip and the first episode he had was when Mike went home to see his father for two weeks. The second week our guy wouldn't eat and just lay around, this was his usual behavior when Mike went away so I didn't think anything of it. Mike came back and he perked up again, all was well, or so I thought. Mike ended up going back because his father was so ill two weeks later and after he left DeeYoGee did it again so again I thought it was just Mike being gone. This time when Mike came home DeeYoGee didn't perk up and that night went off into the spare bedroom where he never went. I went to get him and saw his gums were almost white. He was having a major bleed. It was off to the e-vet and his stomach was full of blood. They could do emergency surgery on him and remove the spleen but the damage was already done. The vet told us with the bleeding, cancer cells are being reabsorbed into the body. We chose to let our boy go that night because the prognosis was so grim.

 

I'm so sorry you're going through this. I hope you have many more good days with your sweetie.

 

I am sorry for your loss. I am lucky that I have the luxury of being with him pretty much 24/7 at this time. He even sleeps in my bed so I can keep a close eye on him at night. In the past when he hasn't felt well, he won't let me touch him. That will likely be my first clue. Fortunately I'm in Boston with lots of resources to be able to let him go quickly. I really hope he lets me know before things get too uncomfortable.

Yes, with the bleeding already occurring and other incidents of cancer, I would have made the same decision as you. I'm so sorry you are going through this....lots of love, quality time, juicy steaks and any other favorite food would be what I would have planned for Dell if we hadn't done surgery.

[Guest Heehoo]

First, what I am about to say does not mean Avalanche's symptoms are from hemangiosarcoma. Am just answering your question honestly. Yes, it sounds similar to my experience with hemangio in my Spaniel mix. The necropsy confirmed hemangio of the spleen & it had already metastasized. It also reminds me of a less severe version of what happened to my 13 yo senior at the end though I did not have a necropsy done to confirm what the actual cause of his collapse was. He had had chronic lymphocytic leukemia for years so some rapid onset, overwhelming, systemic infection was a possibility but his presentation & lab work was consistent with hemangio. In neither case was I really given an option of surgery. Their condition was so severe & devastating that heroic efforts seemed cruel.

 

Would I have chosen surgery had I known a little sooner, before a massive bleed? Certainly not for my senior at his age, with his history. For my then approx. 10 yo Spaniel? Given the benefit of hindsight I will say no. However, I would not have had the benefit of hindsight. She acted more like a 5-6 yo. Probably not but because the odds were poor... How could I say for sure though?

 

Again, this does not mean what you describe is the result of hemangio. Those symptoms cross over too many other illnesses. I wish the best for you both. It is a terribly difficult to be in. You will be in my thoughts & I hope very much he stays hungry & comfortable for a long time to come.

 

ETA: I don't want to say this but I think I should. This of course is very personal so remember I am writing it from my point of view. Have lost three dogs in emergency situations, at least one & possibly two to hemangio. I need to say that the preplanned release of my other dogs was a far preferable ending for me. It allowed me to give them a calm, peaceful departure surrounded by those who loved them. It was painful & there were still some what ifs but nothing like how I felt after the emergency losses. That's me. Others have different feelings, beliefs & past experience that would effect such decisions.

 

Ditto

[Charlies_Dad]

It does sound similar to our GSP who passed from hemangiosarcoma. He was mis-diagnosed by the local vet....who at the time was more interested in showing off to his apprentice IHMO. He stated it was a slipped disc but he was way off. Looking back, the symptoms were there one to two weeks before we had to let him go. I should have gone with my gut as I noticed his gums were not pink and he was in discomfort when he had an 'episode' however he perked back up for several days. The day he left us, was actually around 5am and it was a nightmare for me as I had to drive for an hour while he was convulsing/seizing. I tried to keep him comfortable during the drive but he was scaring the hell out of me. When we finally got to the good vet hospital, they pulled blood from his abdomen and I had to make a decision then and there. I had left it too long for an operation. Had I known and caught it earlier, I likely would have operated.

 

I am sorry you are going through this with Avalanche.

[GreyWrangler]

Wow, that is a roller coaster of a day! I'm sorry!

 

I don't have too much in the way of advice, since it was never confirmed just strongly suspected that T had hemangio.

 

I won't go into the details but T went quick and under emergency care. If you need anything, let me know. I'll be thinking of you and Ave!

 

 

Red too went quickly after never showing a sign f this except for refusing the first meal in his life.

 

Spoil 'em rotten while he can still enjoy it.

[EllenEveBaz]