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Older indoor shy cat, amputation likely, overwhelmed and need advice...
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9 February 2017 - 8:10 pm
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Hello everyone.

I need a little guidance on very tough decisions ahead.

After my vet no longer recommened amputation after the radiologist's report on Jan 18th, I seeked a second opinion.

The new vet, initially seeing the copy of chest xrays done, thought that there was a realistic chance that the "nodules" were aged related fibrosis instead, and suggested taking another xray 2 weeks later.  This second xray was done Feb 8th.  New vet thought that there were no changes compared to the images from 1/18.  However, radiologist consult this time also thought lung mets.  

Radiologist consult basically states "Evidence of multiple nodules from 6 to 8 mm in diameter, consistent with early metastatic disease".

Consult also states that "amputation could be a consideration if with chemo".

New vet is also advising against amputation, as he feels that this will only buy Dusty "a few weeks" and he feels that it's not worth the trouble, although he says that he will do the surgery if I want him to.  New vet is suggesting palliative care with prednisone.

During these two weeks, even on gabapentin, Dusty is using his affected leg less and less (ie, not putting weight on affected leg/landing only with his unaffected leg).  The lump has almost doubled in size.  His demeanor has not changed overtly except I now lost his insta-purr (can't blame the guy under the circumstances).  Dusty's brother (from same litter) is very jealous of him, even hissing at him for no reason at all.  

Mostly, I am SO incredibly frustrated about the vagueness of it all.  There is so little literature about cats with metastatic cancer in the lungs and their survival times.  Of the few resources that I can find, it doesn't even state that the cause of death was lung CA or if the cat was put to sleep.  I don't know whether I should even pursue amputation/chemo route (chemo would be one hour car ride with kitty each way) or put my cat to sleep now.  Dusty is clearly not comfortable and things are not going to get any better; one thing for sure is that I cannot continue to let him live like this.  I'm uncomfortable accepting this fate of "death within few weeks" by lung CA when there really wasn't a "visible" change on the xray seen by the new (no, not a radiologist but a very experienced) vet.  But am I really going to go through the amputation if indeed prognosis to lung CA is "only a few weeks"?  

I'm kind of caught between a rock and hard place as I can't get an oncology consult without a diagnosis, biopsies are of no use at this point as amputation itself is advised against due to the "lung mets", but I can't get an oncology consult without a diagnosis, so on and so forth.  The initial vet felt it was osteosarcoma.  New vet feels that it's more likely fibrosarcoma.  Also, I don't wish for a cure to lung CA, I want him to be comfortable without pain, but does that mean euthanasia or go through with amputation? 

Neither vets weren't able to answer much questions about prognosis after chemo.  I think a lot of cat owners in this area just don't pursue chemo, so they don't have a lot of experience with it.  If you had such discussions, I would love to hear about it.  The new vet said that he can refer me to an oncologist but it really wouldn't do me any good without having a definite CA diagnosis.  

Can anyone answer the following?

How long did it take your cat to start eating and using the litterbox on his own after amputation?  Mind would be a hind leg amputee. 

If your cat had metatstatic lung CA, how long did they live symptom free?  With or without treatment?

What is your experience/outcome with chemo and lung cancer?

I know this is an unfair question:  What would you honestly do in my shoes?  Different perspectives would be helpful.  Financially, I can comfortably spend ~$1,000/mo on treatments.    

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9 February 2017 - 10:15 pm
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I really don't understand why you can't see an oncologist for an opinion. Perhaps the oncologist would give a more definite diagnosis. All of the tests, xrays, etc could be sent to the oncologist before your consultation.

I had a cat with malignant melanoma and was told it would spread to his lungs. I knew it was there when he got a cut little cough. I was told that it if he was spitting up blood the end would be near. He went to sleep before that because the cancer sores became too uncomfortable for him. Perhaps there is little information on lung mets survival time because the cat was put to sleep due to pain from the primary tumour and the lung mets were not considered the cause of death.

If it is a fibrosarcoma then it could be spreading and new tumours will appear. They can be very aggressive and ulcerate.

I know it is hard to say goodbye to Dusty. Dusty's brother has said goodbye to him. He is not jealous of Dusty but afraid of the illness, which he can smell on Dusty.

You have done the best you could for Dusty and he has lived a full and happy life with you. If you choose not to get another opinion from an oncologist, please consider putting Dusty and the prednisone and ensure he has the pain meds needed to be pain free. Also consider putting a plan in place to say goodbye to Dusty. In your planning you can choose the vet and ask about the procedure. You don't have to do it right away if Dusty is pain free.  Love and spoil Dusty until it's time.

I'm sorry you are going through this. I hope a third opinion from an oncologist will give you a clear direction.

All the best in your decision making. Hugs.

Kerren

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10 February 2017 - 4:13 am
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I'm very sorry to hear Dusty is not comfortable and in pain.

Since Dusty is in pain now this needs to be addressed ASAP so you can decide what is best. 

I do not feel your getting the answers to your questions ,but more confusion even after seeing the second vet.

I would want a 3rd opinion and I would want to see a Oncologist . 

Oncologist will be able to provide more insight to what your dealing with and how to proceed.

Chemo is never a mandatory choice , so if you are able to proceed that does not mean you have to do chemo.

Most importantly Dusty needs to comfortable and out of pain, so no matter what the plan is, he is not suffering in the meantime.

If you post where you are located, Possibly someone can help direct where to go from here?

Here is a forum on Veterinary Specialists 

http://tripawds.....referrals/

If you do not find somehting in your area ask here ok? Someone should be able to help you.

The only question I can answer on the ones you asked-

How long did it take your cat to start eating and using the litterbox on his own after amputation?

Purrkins ate and used the litter box the first day he came home. I had to help him in the box the first day. 

Please keep us updated, we are sending you extra strength . 

Hugs to you and Dusty !

Holly & Purrkinsheart

Virginia
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10 February 2017 - 8:49 am
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So very, very sorry you are dealing with this. To have no definitive guidance and/or conflicting from the professionals is so disheartening.

I suppose no changes from the different xrays is a "good" thing. Dusty doesn't appear to be symptomatic from the mets, so that's also another "good" thing.

I know with dogs, some Vets opt to proceed with amputation now in spite of mets. This is definitely a newer way of approaching things from the way it was done in the past. The newer thought process seems to be remove the pain regardless as no one has a cyrstal ball as far as timeframes. Weeks, months, or even year (Reno the dog), it's just a crap shoot that no one can predict.

Generally, not always, met progression in lungs (in dogs) is not "painful". They eventually cause tiredness and some change in breathing pattern. Prednisone is often prescribed to help breathing.

I'm sorry I have zero answers for you. It may come down to this. Which "scenario" would cause you the least "turmoil". And I use the word turmoil because you are in such an awful situation to have to resolve. One scenario, you do nothing and manage his pain as best you can, knowing you will be releasing him probably "soon". The other scenario, you proceed with amputation, he has a "rough" recovery for a week or two, and only gets a "short" pain free time before the mets become a problem. A d then the scenario we would all hope for. You proceed with the amputation a d Dusty gets great extended pain free quality time.

Which scenario woukd you second guess the least, even if it didn't turn out "well"? (Obviously, the "extended quality time scenario" you wouldn't second guess at all!)

Keep us posted. We wish we could help more. In the meantime,SPOIL, SPOIL, SPOIL!! Take lots of pictures! SPOIL SOME MORE!!

Love

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

PS There are no guarantees with chemo either. So doing the amputation doesn't automatically mean you have to proceed with chemo, especially if Vet trips are hard on Dusty.

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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10 February 2017 - 1:42 pm
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I understand your frustration, I would be upset and at a loss as well. I'm so sorry! You're right, there isn't a ton of info on metastatic lung disease in cats, the documentation is so scarce. 

There is an article here about a dog who had mets, but this oncologist thought it was wise to proceed with amputation. If you try to imagine the cat as the patient in this piece, it may give you some perspective:

http://www.petm.....frmUm0QOSo

In my opinion, whether metastases are detected or not at the time of diagnosis, surgical amputation of the affected limb in an otherwise asymptomatic dog is something I will recommend in nearly all cases. I didn’t always feel this way, and this stance is something I’ve adopted through my years of working as an oncologist trying to medically manage the discomfort of dogs with bone tumors.

Get the referral from your vet asap. Oncologists are there TO diagnose. They simply see far more cancer cases than primary care veterinarians, and odds are that one has handled a case similar to yours. Where are you located? We can help you find a good oncologist.

It's better to hop on three legs than to limp on four.™
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10 February 2017 - 1:44 pm
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By the way, I second the opinion that just because you amputate doesn't mean you have to do chemo. We didn't, and our Jerry lived two years when he was only supposed to live six months. Statistics are always just an educated guess, but they are often wrong when it comes to date-stamping our animals' lives after a diagnosis.

I get the feeling that you won't feel good about any decision until you have answers. There's a good chance that an oncologist will give you all the information you need to be comfortable in your choice. Whatever you decide, we'll be here for you and Dusty.

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10 February 2017 - 2:52 pm
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I wanted to add one more note if you do get perscribed prednisone , for cats Prednisolone should be prescribed instead.

Cats metabolize the two meds differently. 

We were told this years ago with our older kitty. Just wanted to mention it just in case . Prednisolone is better for felines.

https://www.researchgate.net/publication/229963049_Bioavailability_and_activity_of_prednisone_and_prednisolone_in_the_feline_patient

Screen-Shot-2017-02-10-at-4.46.41-PM.pngImage Enlarger

http://www.clin.....ednisolone

Screen-Shot-2017-02-10-at-4.32.05-PM.pngImage Enlarger

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11 February 2017 - 8:51 am
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I would like to hear more about what recovery period is like after the amputation.  If mona's mom can tell me how long it was from diagnosis of lung mets to seeing symptoms, I would appreciate it.  Maybe these questions have been asked in the past and I just don't know where to look.

I'm 50-50 on euthanasia vs. amputation.  I am considering amputation route with prednisone and/or chemo.  Cornell is one hour away from me.  If majority of cats recover to doing basic every day stuff in a week or so, then I can do amputation, take chances at these minimally available statistics and proceed further with an oncologist consult.  At least my cat can be pain free for whatever time is left. 

Actually, things are looking a lot clearer after seeing the 2nd vet; I felt that the first vet tried too much to spare my feelings and with keeping my hopes up.  Unfortunately, my new vet says without definitely knowing what CA this is, oncology consult will result in more textbook answers unless I'm willing to go through more diagnostic testing there.  He honestly felt it would be a waste of time/money at this point in time.  The leg needs to be gone for chemo treatments anyway.  So the decision is really whether I amputate or not, and hope Dusty won't show symptoms for a while.  Vet has suggested palliative care due to statics regarding cats with lung CA.  His reasoning is that even we were to amputate ASAP, one month would have gone by since "lung mets" are found by the time staples come out.  Of course Dusty's time can be a lot shorter or a lot longer, but this we cannot know. 

As Dusty's caretaker, there isn't anything palliative about doing nothing + prednisone.  It's the bulk of this mass, kind of nestled between his groin that's really making him hesitant to walk.  His leg has to be spread so far apart for him to walk/squat.  He still uses the litter box and he still greets me at the door, and follows me around when I get home from work.  Other than that, he'd rather not walk.  He is not physically lethargic in his demeanor.  And he's always been a grazer and on the slim side.  Major problem with all this is that when I'm not home bringing him food, he doesn't eat.  When I bring him food he shows normal appetite that he always has, but I'm just not home often enough to get enough calories in him.  I tried mirtazapine which showed only little improvement in amount he ate at each sittings, but he still didn't get up to eat on his own.  It also made him so restless that he probably burnt off all extra calories anyway.  I can syringe feed him and I'm quite good at it.  He actually gained some ounces at recent vet visit.  But this process is stressful for my cat and majority of our time together is turning into getting calories in.  Very far from making him comfortable or spoiling him at the end of life.  I cannot continue to put him live like this if we can't do anything about the leg.  I think I'm getting ready to say good bye to him but I don't want to be making the wrong decision because I was uneducated and overwhelmed.

My family & friends are not very supportive.  They don't understand why I'm putting in so much effort on a 12 yr old cat.  I would love people to chime in and tell me their thoughts about the situation.  If I process all this logically away from Dusty, I feel like putting my cat to sleep soon is the right choice.  When I see the sparkle in his eye, him purring with my touch, with everything else normal as they could be for my cat except for his leg, it's so hard to make that choice.

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11 February 2017 - 9:44 am
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I'm very hesitant to give you any timelines because my experience is based on one cat. Vets and oncologists have the experience and research.

My cat Licri had malignant melanoma (skin cancer) and I was told it would spread with new tumours popping up and would go to his lungs. There was no lung xray because there was no point because the primary cancer was in the skin. He could have already had the cancer in his lungs when first diagnosed with the skin cancer.

Dusty's primary cancer is in his leg and I agree that you need to deal with that first. There are no guarantees that your cat would recover from the amputation and be mobile within a week. First, the stitches aren't usually removed until the 10th day but that's only if it has healed well. It all depends on his health and physical condition. My Mona's xrays were clear, her bloodwork was good, as was her heart. She ate well, was not losing weight, was active and her amputation was done within a week of me noticing a small lump. I'd say everything was in her favour for a smooth recovery. Some cats have more challenges, can get infections and the healing takes much longer. Each cat is different.

Hugs to you and Dusty,

Kerren and Tripawd Kitty Mona

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11 February 2017 - 10:15 am
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How long did it take for your cat to show symptoms after lumps are found?  I know it's based on one cat and we're definitely talking about different cancers.  I'm not naive enough to decide on my cat's treatment plan off of your experience so please do share with me.  One cat's experience is better than none.

I would seek oncology referral if I knew I have the time for amputation and all that.  If my kitty starts showing symptoms of lung CA not even having had a chance to recover from amputation like the statistics/timeline says, then it's obvious that I have to draw the line here.

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11 February 2017 - 11:00 am
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Just want to add as far as family and friends not being particularly supportive, yeah, we hear that a lot around here!

YOU have the bond with with Dusty! YOU are doing the research and have far more information than they! YOU have ro live with the decision, whatever it is! Mets aside, 12 is not THAT old for a cat!

This may sound silly, but what do you think Dusty would want? Do you think Dusty would want to proceed with the amputation with the hopes of some pain free quality time for more loving and spoiling? Do you think Dusty knows he's had a lifetime of loving and spoiling already and is at peace with heading to the Bridge?

I know seeing him like this IS overwhelming and exhausting emotionally and physically! It's hard to visualize him walking pain free on three legs, but that is the purpose of amputation. Having mets thrown into the mix certainly makes this "forced choice" much harder.

Try and get in a calm quite space with Dusty. Sit with him. "Talk" with him. See if you get a "sense" of how would he like to proceed.

((((((((((((((((((((((((((((((((((((((((HUGS))))))))))))))))))))))))))))))))))))

Sally and Alumni Happy Hannah and Merry Myrtle and Frankie too!

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

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11 February 2017 - 12:50 pm
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purrkins said
I wanted to add one more note if you do get perscribed prednisone , for cats Prednisolone should be prescribed instead.

Cats metabolize the two meds differently. 

You help educate us every day Holly. Thank you, I didn't know this.

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11 February 2017 - 1:01 pm
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I can see the vet's point of view, but still, I feel like no vet should say specialty care referrals are a waste of time. 

Aside from that, don't feel bad about asking these questions. We want to know as much as possible about feline amputation decisions like this and yours is certainly one of the tougher ones to make.

I'm not in your shoes, but I can tell you this: one, disregard anything your friends and family say. Dusty is not THEIR cat. They haven't done the research the way you have, they don't know him like you do and my guess is they've never had to make a similar decision for an animal they truly loved. With cats' ability to live extraordinarily long lives, 12 years old is practically middle aged for most kitties. 

I'd like you to read this post by a member who's dog Max just passed, two months after amputation. It's sad, but here's what his mom said:

Would we make the decision to amputate again? YES!!! Definately! We had some beautiful moments with him in the last few weeks. He was happy and in no pain. We had our moments to love him that little bit more and squeeze him that little bit tighter.

Nobody can guarantee your kitty won't have issues after amputation. We've seen it happen once or twice and the humans' were extremely upset that their cat didn't recover the way they had hoped. Yes there is that risk, and worst case, he may not even make it past the surgery. We've seen that happen too, with dogs but as of yet, no cats thank goodness. But, based on what we've seen here, most animals will recover and enjoy extra time with their humans. Knowing how much time is anyone's guess of course. 

If you decide to proceed I would want to make extra sure your vet is practicing the latest pain management and anesthesia protocols. We strongly recommend AAHA-credentialed hospitals for this reason.

I hope this helps.

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11 February 2017 - 2:50 pm
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shycat said
How long did it take for your cat to show symptoms after lumps are found?  

I'm sorry I can't remember since it's well over 10 years ago. Maybe 1 to 2 months before the coughing started. It was never a bad cough because I had him put to sleep because the ulcerating tumours became too uncomfortable for him.

It may be helpful for you to read Fredo's recent blog and post:

http://alfredo......ther-shoe/

http://tripawds.....2/#p183877

If I understand correctly Fredo had osteosarcoma, leg amputated 2 years ago, started losing weight and coughing/sneezing a couple of months ago. Lung mets found recently. He will likely go on prednisolone and a bronchodilator.

I hope this helps.

Kerren

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I'm so sorry to hear about Dusty. heart

Our experience was a bit different from yours (osteosarcoma, forelimb, no lung mets), so there are a number of things I can't speak to firsthand, but I'll chime in where I can.

How long did it take your cat to start eating and using the litterbox on his own after amputation?  Mind would be a hind leg amputee. / I would like to hear more about what recovery period is like after the amputation.

Nicholas is a right forequarter (shoulder and forelimb) amputee. After the surgery, he ended up having to spend an extra night in the clinic because he was slow to wean off of IV pain meds. He was eating well, relatively mobile, and using the litter box from the moment he came home, though there was the occasional positioning-related accident (he's a large cat, and would sometimes miss the rim of the box) during the recovery period. He was playing within a week, and jumped onto "his" couch for the first time two weeks post-op. There were some issues with phantom limb pain, but he responded well to gabapentin.

Nicholas' biggest frustration was the difficulty of attempting to bury things with one forelimb. It took him months to adjust to this. Today, he still goes through the motions (you can see the muscles moving at his amp site as though he were actually using the missing limb), but it no longer seems to bother him that nothing happens.

Every cat's recovery is going to be different, but this was our experience.

New vet feels that it's more likely fibrosarcoma.

With a possible fibrosarcoma on the right rear limb (where rabies vaccines are commonly given), did your veterinarian mention anything about “injection site sarcoma” or “vaccine associated sarcoma”? If this is believed to be an injection site sarcoma, it is possible that the vaccine manufacturer may reimburse some of your costs if you decide to proceed with treatment. This may be worth discussing with your veterinarian.

I really don't understand why you can't see an oncologist for an opinion. Perhaps the oncologist would give a more definite diagnosis. All of the tests, xrays, etc could be sent to the oncologist before your consultation.

It isn't uncommon for oncologists to require a firm diagnosis (if possible) before a consultation, because it is hard to provide useful information without a diagnosis. Prognosis and treatment options are pretty heavily dependent on what it is that you're dealing with.

If you're interested in exploring all your options, there is no harm in talking to an oncologist. A consultation is just an opportunity to get more information. What you do with that information is up to you. It doesn't mean that you have to pursue treatment, and pursuing treatment doesn't mean that you can't change your mind later on.

We met with an oncologist last year when one of Nick's littermates developed a mass in his chest. He was wonderful. We tried an experimental chemo protocol initially, and pursued surgery when he didn't respond to the medication. Had we chosen palliative therapy (which was discussed at length during our initial consultation) instead of a more aggressive option, I have no doubt that he would have been just as supportive of our decision. There are so many variables, and the right decision for one pet/family may not be the best option for another.

I think I'm getting ready to say good bye to him but I don't want to be making the wrong decision because I was uneducated and overwhelmed.

Know that whether you choose surgery +/- chemo (if available), palliative therapy, or euthanasia, there truly is no "wrong" decision here, as long as you keep Dusty's quality of life in mind (and I know that you are). He is lucky to have you.heart

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