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Recommend to Amputate or Not?
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21 February 2018 - 7:22 am
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Hello, I have a 15-year old lilac lynx point Siamese who was diagnosed with Squamous cell carcinoma on his paw in November. One digit was amputated from his front right limb in the first week of December, and the tumor grew back within a month. We've done a CT scan at the end of Jan after x-rays that were inconclusive/different opinions from radiologists prior, and a mass was found in the lungs, approx 1cm. This may not have changed size from the first x-ray two months back, according to the estimated size from first notice of a potential mass in x-ray. Because they were unable to aspirate the mass in the lung, I am not sure of what it is exactly. The concern has been whether or not it's Feline Lung-Digit Syndrome, and it was suggested that it would have traveled from the digit to the lung, if it were the case. The front right limb has been the only one with tumors/masses.

Below is the CT report assessment:

Following general anesthesia, 2 mm contiguous slices of the thorax were obtained pre-and
post contrast administration. In the caudal mediastinum immediately ventral to the esophagus, a round
to oval soft tissue mass is seen with patchy ring enhancement. This is contiguous with the mass
involving the ventral aspect of the right caudal lung lobe, which appears to wraparound and indented
the right caudal lobar bronchus. This mass does not appear to extend to the chest wall. Enlargement of
the right hilar lymph nodes is seen ventral to the right middle lung will bronchus.
ASSESSMENT: enlarged thoracic lymph nodes with ring enhancement, and focal infiltrative process in
the right caudal lung field as described. Considering the age of the patient, neoplasia is most likely.

It was suggested not to do an amputation of the limb because of the finding of the lung mass at the time. Since, the tumor has spread along his paw and has been pretty aggressively moving across his digits and into his ankle, with some parts of the pad and the part where the one digit was removed, having open "proud flesh" & bleeding. We clean & wrap his paw nightly because of this, although this process is very painful for him.  He's currently taking Buprenex 3x a day and CBD infusion 10-20mg/daily in coconut for pain, which he has done well with. He was also given an Onsior shot on Valentine's Day and had been on oral Onsior prior but with resulting lack of appetite. He's also taking a number of herbal / holisitic supplements that are part of a cancer protocol, including recently adding Yunnan Baiyao, which seems to have helped with the bleeding (which was getting pretty bad) of the paw.

I know the paw is causing him pain and stress, and not knowing if the cancer has spread elsewhere, what is clear is that the paw is really keeping him from enjoying life at this point. After discussing with vet, and acknowledging that because of the lung mass this would be a palliative care surgery, I booked an appointment to have the limb amputated on Thursday, but am second-guessing whether or not this is the best decision in light of some recent changes. 

He's been losing weight slowly, and is now pretty skinny - approx 8 lb 4 oz presently. He has some appetite still, though has had to be syringe fed a handful of times in the past week. Mirtazapine seems to help a bit with appetite. I worry that he's too frail to have a good turn-out from such a major surgery/limb amputation. 

He has good days and bad days, but just in the past few, he began no longer jumping up on couch/bed, pooping in a corner of the house, & he urinated on the bed. These are the first times he's gone outside of the litter pan in his 15 years since I adopted him as a kitten.

He had been coughing for awhile after the digit amputation, but that has stopped now for at least 2-3 weeks. However, I noticed his breathing the past few nights while doing the bandage change and syringe-feeding - things that upset him anyway - has been heavy/more audible/labored, which is concerning.

He definitely has points each day where he hops about (keeping the wrapped paw up mostly) and is perky, but mostly sleeps and has been hiding often.

I also noticed that one of his back leg toe nails (not on the effected paw) has a little darkening/looks like blood within the nail itself. This worries me because as I recall, the first sign of the initial tumor growth was similar to this. It took weeks to manifest as a tumor, and am really hoping it's just something within the nail, and this is not the first sign of the same SCC on this toe. It would definitely effect my decision to amputate the front limb, but seems to early to tell unless that could somehow be tested?

Those are my concerns that have me second-guessing the amputation - his weight/weakened state/lack of appetite, the potential nail issue, labored/heavy breathing under stress, and change in bathroom habits. I'd like to attribute most of these to the cancer and think that removing the limb would alleviate the problem, but I also realize it's a major surgery and comes with its own pains and adjustments. He's been pretty strong so far, and surprised me by bouncing back heartily from that first digit amputation, and following low points over the past few weeks, with days where he seemed like his old self, but as aggressive as this has become, I feel like if we don't go forth with an amputation, we could be looking at euthanization soon because of his level of pain and quality of life, as I don't want him to suffer. But I feel like there is hope for him to have more time/good life if he can make it through this surgery.

I'm looking to get some advice on whether or not the amputation of the limb would be recommended in this situation. He's my little sweetheart, and I love him beyond words. 

Sorry that this is lengthy, but I greatly appreciate your help!

Crystal & Spirit

Michigan
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21 February 2018 - 9:51 am
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Glad you posted here Crystal!

Amputation is scheduled for tomorrow Dr Pam I did not see Crystal mentioned when.

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21 February 2018 - 7:31 pm
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Yes, tomorrow is the planned drop-off, thanks Holly! 
And additionally, after talking with regular vet, I plan to request to have at least the back limb that had the blood in the nail x-ray'ed beforehand/tomorrow morning, in case something might be going on there, though there is no swelling or other indications at this time.

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22 February 2018 - 7:38 am
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Usually lung-digit syndrome is carcinoma and actually the tumor starts in the lung and metastasizes to the toes.  Sometimes more than one toe can be affected.  Squamous cell would start in the mouth or toe and travel to the lungs.

If he is painful and there is only one toe lesion right now then I would consider amputation because it would help his comfort level in the short term.

Pam

Canada
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22 February 2018 - 7:42 am
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Good morning Dr. Pam

from what i understand, Spirit is on his way to get an xray and then go in for his amputation. We are all praying and hoping for the very best outcome for Spirit and Crystal!

All the very best to you

Petra, Stewie and his Pride.

On July 10/17 I became a Super Tripawd! You can find out more about my Pawrents Allensong but first Check out my 🎗 journey Super Stu Remember...“live in the moment!“  

Michigan
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22 February 2018 - 8:13 am
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Thank you for your time Dr Pam!

The Rainbow Bridge

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22 February 2018 - 10:23 am
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Ditto, thank you Dr. Pam, you are the best!

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26 February 2018 - 5:21 am
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I really appreciate the input! I felt much better about the decision to amputate after reading this.
Thank you! heart

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