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.    

I'm so sorry to hear about Dusty.

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.