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Feline Radiation - Advice Please!
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Member Since:
28 April 2023
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5 June 2023 - 9:31 am
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Greetings Tripawd family

 

My cat Banksy ( 5 y/o) had a lump pop up on her hind right leg but since she's long haired, we caught it fairly late. It ended up being a soft tissue sarcoma, high-grade (grade 3), consistent with vaccine associated sarcoma. We immediately agreed that amputation was necessary - I grew up around tripod pets so it was an easy decision. The tumor was completely excised but there was one area where the margin was the minimum they like to see - 3mm with fat and nerves. Her mitotic count is just a 10 so we're not worried about that. 

 

We were told by our surgeon that since that one margin is just 3mm, he recommends talking to a radiologist. He said if we decided against that, it's fine since he's very confident about what he accomplished in surgery. We were finally at peace that she's cancer free, but when I spoke with the radiologist all of the horrors popped back up. The radiologist said we would have to pay $13,000 for 19 treatments, Monday through Friday for consecutive weeks. She would have to be put under anesthesia every single day with a feeding tube and they would insert a catheter on Mondays and take it out on Fridays. There was such a lack of empathy in that phone call and we were given no information on side effects, other options, case studies, etc. It felt like a sales pitch... They keep calling to ask if we're going to go with radiation and they are using fear tactics saying if we don't, she might only have a year to live. This is in direct contrast with what the surgeon has said. 

 

I know I'm in an emotional state with all of this so I'm coming here to try and ground our decisions in facts. Putting my cat through actual torture for over a month and pay an amount of money that will cripple us when the outcome of zero recurrence isn't guaranteed? Or do I trust the surgeon and hope he did get it all? 

 

Or is there another option that we aren't thinking of? Chemo? Other types of medicine? Extensive monitoring? Any and all advice is so so appreciated as we try and make the right call that's the best for our girl!

The Rainbow Bridge



Member Since:
25 April 2007
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5 June 2023 - 10:19 am
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Oh yikes I'm sorry for the rough experience!

Getting all of a soft tissue sarcoma is really tricky, even for the very best surgeons. Is the surgeon who performed the excision an oncologist? If not, has an oncologist reviewed her case? Did staff from the clinic you talked to on the phone review her case?

There are newer methods of radiation therapy that don't require as many visits (usually 3-5 at most), but do cost as much if not more. That's a tough amount to deal with for anyone, it's incredibly expensive. You are NOT a bad pet parent if you opt out of therapy, I promise! I know that a cost like that would be out of my price range! Being in debt and stressed over money bills is not going to make your Banksy happy, nor is it going to guarantee the cancer won't return. It happens!

You could play it by ear, and possibly pursue electrochemotherapy or intralesional chemotherapy IF cancer returns. Those methods cost a fraction of traditional chemo, which is probably one reason why we don't see them offered here in the States very often. That, and the studies are all done in Europe and many vets here aren't comfortable with the low amount of research behind those therapies. But we have seen a handful of Tripawds members have success with those treatments, so that's why we continue to let folks know it's available by a limited number of vets in the U.S.

We will always support you no matter which way you go! How is Banksy doing otherwise?

Virginia







Member Since:
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5 June 2023 - 4:38 pm
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WOW!!! Just WOW!!!

Cannot imagine putting Bansky through all that.  The massive number of days with sedation....the feeding tube....the catheter...WOW!!   Cannot  imagine Bansky could come out of all that with no other issues. As we all know QUAILITY  is always at the forefront of every decision  we make for our animals.

I cant help but give credence  to the way you felt about Radiologist  and their "tactics".   Reading that part of the post did not settle well with me either.  Sometimes the answer shows up in your  inner voice, the feeling in your gut, your intuition.

 

I really try hard not to say what I would do....but you asked....sorta'.My gut, based on. what the Surgeon said, would be to go with his assessment.   Even of I had the money, that is what I would do.   And what would Bansky want? 

If you go with the Surgeon's assessment, write down all the reasons.  That way, you will always be able to recall the positives of why you went that route.

Regardless, you will always have our support no ,after what.  And apologies Miami crossed the line in expressing  mu viewpoint.  It was just a FWIW thought.

Hugs 

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

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!

The Rainbow Bridge



Member Since:
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5 June 2023 - 5:57 pm
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That is so true Sally! Even if I had an endless source of funds to pay for treatment, in this case, I would take the wait and see approach just based on what the clinic said.

Everyone is different though so please know that we respect all decisions, this is a no judgement zone.

Member Since:
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6 June 2023 - 8:52 am
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Thank you for the compassionate replies!! Reading those felt like letting out a breath I didn't know I was holding. Of course our number one priority is doing what's best for Banksy but this feels like such a grey area and having my feelings validated in this space gives me such peace.

Jerry, to answer your questions: No the surgeon was not an oncologist. I think our next step is to try and find a general oncologist to get a second opinion from. The staff from the clinic called (again) this morning to see if we wanted to schedule radiation (didn't ask if I had any further questions). I told them we just simply cannot put her through that many treatments when she still doesn't feel like herself post-op. I asked if there were any other options they could provide and she said no - since there is no tumor to treat, the number of treatments is to zap the entire area where the surgery occurred. If there WAS a tumor to treat, it would be maximum 6 treatments. icon_rolleyes I'm still not sure if that's the answer I was hoping for. 

Sally, you're precious and I SO appreciate your take on this! My family keeps chanting the same thing you just did - trust your gut. And my gut is telling me this path isn't the right one right now. 

Banksy is doing well! If she forgets the leg is gone, she runs around like she used to. But she has moments where she "throws a tantrum" and can't get her 3 legs to work together. We're hoping that goes away with time. We can tell we've lost some of her trust already with the amputation so that's why we're extra hesitant to waste any more time further traumatizing her. 

The Rainbow Bridge



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6 June 2023 - 10:44 am
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Ahhhh now I get it about the # of radiation treatments. Sounds like they do the stereotactic radiation therapy as well, but in a case where no tumor is present for now they have to zap the whole area. That's why they went to vet school! I learn something every day. But still, I understand your hesitation on the therapy, that is a LOT for any animal and especially one who does not do well after any kind of procedure or anesthesia.

Yes, see an oncologist for an opinion. They may guide you to radiation therapy again, since that's what they do, but at least you'll have that information so you can make a "leave no stone unturned' decision that works for you and Banksy. 

Always trust your gut!

In time Banksy will find her sea legs, and understand that life is the same but different. Animals are remarkably resilient, it's one of the best lessons for us all.

Keep us posted.

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19 July 2023 - 11:31 am
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Hi tripawd family! 

Coming here to give a positive update and share some information that I hope will be helpful to anyone in this same situation. 

As stated above, we decided against radiation - our lack of trust in the doctor was the ultimate reason and also 3-4 weeks of daily visits to the vet, going under for 2 hours, having a leave in catheter... All for $13,000 minimum. We just couldn't bring ourselves to put her through that.

Jerry and Virginia suggested reaching out to just a regular oncologist instead of a radiologist. None of the 4 vets that we'd spoken to since this began (primary vet, surgeon, emergency room vet, radiation oncologist) had said we should / could do this. I wanted to do the "no stone unturned" approach so I made an appointment for a telehealth call to see what options were available, if any.

This oncologist has been incredible. She started off the conversation saying we absolutely had options. Radiation was just the most effective option available but not the only one, as we were lead to previously believe.

She outlined two different types of preventative chemotherapy that are designed to target any possible remaining cancer cells and make her body a place where they cannot multiply, effectively starving them of what they need to grow and will ultimately slow progression of recurrence.

The first option, Doxorubicin, came with some risks and side effects. Banksy (the kitty in question) has an above average water intake. We've tested her kidney values and they're fine but we can't rule out that she has some sort of renal disease. Doxorubicin has been known to cause renal complications. It would also weaken her immune system which could cause other issues. If we'd done this, it would have been 5 doses of chemo through an IV over 3 weeks for $700 per dose (much more reasonable than the radiation). 

The other option, metronomic chemotherapy , is what we're going to try instead. It's a daily pill administered at home over the course of a year. This fits with our lifestyle since I work from home and we've never had issues getting Banksy to take a pill. The dose is extremely small and has almost no side effects. Maybe some GI issues down the road. We'll need to handle the pill and her litter with gloves and be very careful, but they said our other cats are fine interacting with her and using the same litter boxes as the dose is so small it wouldn't make a relevant difference in their lifetimes to cause damage. The cost will end up being ~$60/month for the medicine which is shipped to our house. The oncologist made sure we knew the money for the medicine went to the pharmacist, not her department. 

Both of these options supposedly have the same efficacy. Survival rates would be extended significantly - she's only around 5 (we don't know exactly how old, she's a rescue) - but most of the numbers we're given are based on older cats. No one really knows exactly what will work in this case. 

After giving Banksy a physical exam, blood work, and an x-ray to make sure there's still no metastasis, she said she would be content to only monitor her since she's still cancer free 2 months post-op. I asked her if there would be any reason we shouldn't move forward with chemo even though she's cancer free and she said there's no reason not to other than lifestyle change and cost. 

I don't think I would have personally been able to just do nothing and hope surgery alone eliminated all the cells - this was a grade III tumor. So we're taking action and trying to do best by our girl! 

 

THANK YOU to Jerry and Virginia. I've been singing your praises to my friends and family - there's a chance this forum added years onto my girl's life. 

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19 July 2023 - 11:35 am
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Here's a picture of Banksy a few days post-op! We got her surgery suits instead of a cone so that's what she's wearing here. Her grandma (my mom) sent some cute mugs from Etsy.

Virginia







Member Since:
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19 July 2023 - 1:54 pm
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Banksy is beautiful,  absolutely  beautiful!!!  Thanks so much for sharing the pocture.  And the mugs are priceless.   Banksy has a very  loving  Grandma♥️

Okay, you've done your research, talked to the professionals and have a good working  relationship  with some  you are most co fortavle  with.  That's important.  And what you are doing is non invasive and no side effects (almost none anyway).  

Tha ks so mich for the update and for sharing your thought processes.  Banksy is so lucky to be so loved and to have such a good advocate.

Keep us posted!

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!

The Rainbow Bridge



Member Since:
25 April 2007
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19 July 2023 - 2:01 pm
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WOW! Way to advocate for Banksy! smiley_clap I'm really glad you were able to find someone who would give you ALL the options and take your requests more seriously. Banksy is so fortunate to have you for her hoomans.

Thank you for stopping by to let us know. We are all giving Banksy a 3-paw salute and you too for being so pawsome!!! 

And thanks for the adorable photo too!

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25 September 2023 - 7:34 am
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Hello again!

 

Hopping on to give another quick update in case anyone finds themselves in this exact or similar situation:

 

Banksy has been doing GREAT - energy levels have been high, she's been affectionate, nothing too concerning. We took her for her monthly checkup and found she had lost .7 lbs - not abnormal for a cat on chemo but it was still enough of a drop in a month time span that we wanted to double click into it. She's a very food motivated cat and loves her wet food but after this visit I really started to pay attention and she wasn't eating the same volume she used to. 

 

One of the main side effects for this type of chemo (chlorambucil) is loss of appetite. So our regular vet prescribed Hill's wet cat food that's specifically for cats with cancer. 

 

Fast forward a few days and the oncologist calls and tells us that the blood results from that checkup are "alarming". Her white blood cell count is very low. I wouldn't call it "common knowledge" that chemotherapy effects white blood cells, but if you've had a family member (including a animal) with cancer, it's probably been talked about. Combine this with the fact that the entire reason we test her blood monthly is to check for her white blood cell count to see if we need to ease up on her dosage (she's currently taking the highest dosage possible). So when the oncologist's office (the doctor never got on the phone) tells me her counts are low, I take it in stride. BUT. Then they try and convince me it's so abnormal! "Most chemotherapy does lower white blood cell count, but THIS one shouldn't! We don't know what's happening!" While that might be true, let's use our brains here. This cat has had more blood tested in the last year than any animal I've ever known. And we're really going to sit here on the phone after 2 months of chemo and act like her white blood cell count being low is something besides the chemo...? 

 

So where are we today? They told me to pull her off of chemo for 2 weeks because they think she has some other illness that's causing the weight loss and white blood cell count. I wouldn't call it a "scare tactic" like I've experienced in the past, but it sure feels like they're wanting more to be wrong with her than there actually is. And I COMPLETELY understand that they need to cover their bases. But it makes it very clear that once again, I'm Banksy's biggest advocate in the room! 

 

I'm getting her blood checked again after the 2 weeks and we'll go from there. She's scarfing down the new food with ease so my guess is her weight will be up and those cell counts will skyrocket! I haven't decided if we'll keep her on the chemo - if they try and tell me that this medicine "isn't a good match" for her, we might decide to not move forward with any treatment. The other options were just too risky and she's living a wonderful cancer-free life right now. 

The Rainbow Bridge



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25 September 2023 - 11:02 am
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Good to hear from you, thanks for letting us know how she's been doing. She's such a bounce-back girl thanks to your advocacy.

I agree, pulling her off chemo and preparing for something else is to cover all the bases just in case. It sounds like the change in plan right now is a wait and see approach, not additional diagnostics? If so that will be good for Banksy and you (and your wallet!). 

Enjoy where she's at right now, happy and eating and being the same old Banksy! Every day together is icing on the cake. Got any new photos of your gorgeous gal?

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