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Jellica's SCC of the Jaw
10/2/02 We took Jellica, our 12 year old cat, to the vet today. My husband had noticed that her cheek looked strange last night and she was rubbing it with her paw in a very unusual way, so he called the emergency vet. They said that it was probably just be a cavity (although she had a routine dental cleaning done earlier this year, and it was fine), and they recommended that we take her to our vet in the next couple of days. He took her in first thing in the morning, and as soon as the vet looked at her, he said that she had a broken jaw. They will keep her overnight and x-ray her tomorrow. 10/03/02 Terrible news. Our vet told us that Jellica has bone cancer. He didn't want to do a biopsy, because he says that would cause the cancer to get really aggressive and grow much faster. He offered to send us to a specialist, and I asked for the first possible appointment. They can't get us in until October 21st. In the mean time, another vet who works there seems to be slightly more optimistic that it may not be bone cancer, but a calcification of some sort. 10/3 - 10/20 In the meantime, we keep a close eye on Jellica. The x-rays showed that her lower left jaw has actually been broken, and it is obviously misaligned. Thus, she isn't eating dry food. We have bought her all kinds of wet food, and since she really loves turkey (the lunch meat type) and crabmeat, we have purchased those items as well. We are chopping everything up very, very fine, and she just sort of licks it up. Sometimes we have to really entice her to get her to eat. There are times when she runs out to the kitchen, like she's really hungry, only to turn her nose up at everything we offer. The one thing that she'd eat yesterday will be refused today - so it is hard to plan. We are finding that at times, she'll turn down crab to eat wet cat food. It's very hard to understand, but we are getting through it. She's a small cat to begin with (8 pounds or so), and she has probably lost about a quarter pound. She still is very much herself, though, in every other way. She is playing, grooming, and snuggling. She also still hisses at the other kitties like normal, and is more than happy to punch you in the face if you move her when she doesn't want to be moved - just like normal. She still sleeps between our two pillows at night, and likes to be pet in her special way. When I pet her under her chin, I can feel the tumor. It seems like the area is a little tender, but she really like for it to be scratched in a very gentle way. I hate that tumor. Occasionally when she yawns, it looks like she gets a little spasm in her jaw. She also tries to scratch it herself occasionally, and she also rubs it occasionally with her front paws. 10/21 We took Jellica to the vet specialist today. When we got there, the oncologist's tech got all of the information, took vitals on Jellica, and then reported back to us that the oncologist thought that we should be seeing the surgeon instead of her. So, we waited for the surgeon to work us in (after we waited almost three weeks for the appointment with the oncologist - it figures). I should mention that Jellica is terrible at the vet and in the car. She is generally a very relaxed cat - queen of the house - but the moment she sees the cat carrier she becomes a meowing ball of stress. She trembles, she whines, she drools uncontrollably when the vet actually touches her. If we are going to the vet once a year for a 15 minute visit, then her behavior makes you chuckle and feel bad for her. But to drive her twice as far and then sit in a waiting room for two hours for a surgeon is borderline animal cruelty - at least that is what it felt like. When the surgeon came in, he immediately suggested the biopsy. He said that bone cancer (which was what our vet had diagnosed Jellica with) was extremely rare in cats, and that Jellica may just have a mineral deposit of some sort. He said that if it were cancer, the biopsy would have no effect on the speed with which the tumor grows. We agreed to the biopsy, and he had us come back in an hour and a half to pick up Jellica. He said they would call us with the results in 4-5 days. 10/28 We called the vet today, since it had been 7 days and we hadn't heard anything. They said Jellica has Squamous Cell Carcinoma (SCC), and we set up a consultation for Wednesday morning with him (the surgeon) and the new radiologist who just moved here from Maryland. While the diagnosis has ripped me apart, Jellica doesn't seem bothered. She is still herself. In retrospect and after reading everything I could about SCC, I realize there was one particular warning sign I should have picked up on. Jellica has had particularly foul cat breath for the past six months or so. I thought that it was just part of aging process for cats. But, bad breath is a symptom of many oral problems. I will never forget this. 10/30 Had a long consultation with the radiation oncologist and surgeon today. They gave us copies of veterinary studies and information on Jellica's disease. Our treatment options are: Surgery + Radiation (recommended) - They will remove part of the left mandible and a small portion of the center of the right mandible. The surgeon is optimistic that he will be able to leave enough tissue in place for Jellica to have good oral function. He says that if it looks like he will have to take much more when he actually starts to perform the surgery, he won't do it. He seems to have her best interest in mind (God, I hope). Two weeks after the surgery, we will start taking Jellica to Monday through Friday radiation treatment for four weeks. All said, cost will be about $5000. (As of today, we have already spent $600, just to get the diagnosis.) The one year survival rate is 57%, and the vet seems to think that if we can get her past the first year, then she should be able to live for another three years or so. Radiation + Chemotherapy - This entails four weeks of Monday through Friday radiation therapy in combination with chemo drugs. This should add 3-8 months to her life expectancy with SCC. She would probably not live out the year. Cost would be about $3500. I'm not too thrilled with this option. Surgery Alone - Same as surgery described above without the radiation treatment, but the surgeon would have to take more bone and tissue in order to get the cancer that the radiation would otherwise kill. Median survival rate is a measly month and a half. Cost would be about $1500. This is not the option for us. I can't see subjecting Jellica to the trauma of losing her jaw and teeth, just so she can die a few weeks later. Palliative Radiation Therapy - This is for short-term quality of life. There would be a once a week high dose radiation treatment given for four weeks. This would shrink the tumor, but it would just basically be a race to see whether the radiation or cancer killed her first. Total cost $1100. This is not aimed at extending life, really. Since Jellica doesn't seem to be in a lot of pain right now, this treatment isn't for us, either. So now we have to decide whether to do one of these treatments or nothing. As I've mentioned, Jellica hates to travel, and she hates the vet. The thought of forcing her into the kitty carrier everyday for radiation is really what is really bothering me. She's not going to understand that we are trying to help her - it's just pure torture to her. Secondly, I hate taking her in for a surgery that is going to permanently disfigure her. I have read all of the stuff online from people who have gone through with the surgery, only to say that they will never put a cat through that again. But, I haven't heard from anyone who did the surgery with radiation, and the surgery admittedly only extends life for about a month and a half. This decision is killing me. They only do surgery on Tuesday and Thursday, and they can't get her in tomorrow. So, they told us to take time making the decision, and they will get her in on Tuesday next week for the surgery, no matter what, if we decide to do it. 11/01 We went to check out the radiation therapy facility today. We were hoping to see some pet owners with similar cases to ours, but we only ran into a dog owner from Cleveland (she drives her dog the 2 1/2 hours to Columbus, because this radiologist is the only one in the state that performs radiation therapy). The facility is actually for humans - the pets wait upstairs until the last patient leaves at 4:00, and then the vet radiologist has free reign of the equipment. They give the pet a small bit of gas, and then insert a trachea tube to administer the rest of the anesthesia. Then they put the pet on the machine and let it do the work. Jellica would be getting radiation concentrated on each end of the bone that remains after the surgery and in the lymph node region of the neck. The idea is that the radiation will kill any microscopic cancer cells that weren't removed in the surgery. The facility is very nice, and the one dog we saw looked very happy, but it is a long drive for our house. We left a voice mail for the radiologist to see if she can prescribe something to "take the edge off" of the ride for Jellica. I'm not sure they can though, since they will be anesthetizing her upon arrival. Is this the right thing to do? 11/03 We've made the decision. We're going to do the surgery + radiation. I just don't want to feel like I didn't try hard enough for her. I want to give her a fighting chance. She's a tough cat. Gosh, I hope this is the right thing to do. 11/04 Tomorrow's the surgery. Jellica's fine. I'm a complete mess. She has been such a wonderful and true friend - she's outlasted friends, apartments, and boyfriends. She's been with me throughout my entire adult life. She came into my life when I was fifteen - a little, rain soaked pathetic looking kitten that someone had dropped off in front of my parents' house. I wish I knew exactly how many times she's made me smile. How many kisses have I given her? How many times has she bitten my nose when she is feeling loving? Jellica has this cute habit. When I come home, she actually gives me a hug. She sits on the back of the couch, I walk up to her and she stands up on her back legs and stretches one paw on each of my shoulders, pauses to sniff my nose and lips, and then meows a hello. I don't ever want that to end . . . 11/05 The surgeon called this afternoon and said that the surgery went well. He was able to leave more of the jaw intact than he had initially planned. She still has her right, lower canine. He said she hadn't eaten yet, but was resting comfortably. I called later that night and spoke with the Tech, who said that she was still sleepy, but doing just fine. They think I should be able to take her home tomorrow. 11/06 When I called this morning, the Tech said that Jellica still hadn't eaten, and that they probably wouldn't release her today. Knowing that she has been very picky lately, I stopped and bought some cans of Fancy Feast (her current favorite) and went to see her. When I arrived, they said that they don't normally let people go to the back to see their pets, but they made an exception for me. Jellica was on an I.V. and was very stinky, but she was very excited to see her mommy. When the Tech saw how Jellica perked up when I came in, she recommended to the surgeon that they release her. She said that the difference in Jellica's demeanor was night and day when I walked in - before she had been somewhat despondent and "depressed." They gave me take home instructions and an antibiotic, and we were on our way home about an hour later. Uncharacteristically, she was extremely quiet on the way home. As soon as I let her out of the cat carrier, I noticed how hard it was for her to adapt to the e-collar that she would have to wear for the next two weeks. She would bump into things, the jolt would freak her out, and she would take off. I had to chase her, because the take home instructions said that she was not supposed to do any running - obviously chasing a cat doesn't make the cat very calm. She was very agitated all day. When I offered her food, she would get excited as though she was starving, but then she wouldn't eat. She just hovered over it. It's like she forgot how to eat. I was very surprised by how much they shaved her! Her neck and face (up to her eyes) have been shaved, in addition to some of her paw for the I.V. She is very bruised from the surgery, and her remaining canine has already shifted to be in line with the center of her nose. She looks pretty rough, but I still think she's a pretty kitty. 11/07 It was a sleepless night followed by a frustrating day. Jellica was very uncomfortable last night until about 4:00 am. She kept trying to scratch, and although the e-collar prevents that, she still scratches at the e-collar. It makes a lot of noise, and I'm sure it can't make her feel any better. But, she finally settled down and got a little sleep. She still seems very agitated. She didn't eat all day, and I was very worried about it. I called the surgeon, and he said not to worry about it for another three days (three days!). My regular vet, though, called to check up on us tonight, and she was a little more worried about her not eating and recommended that I get a little more aggressive with it. So, I did. I had already tried force-feeding Jellica, with no success. This time, instead of a syringe, I just used my finger to get a little bit of food in her mouth. I didn't have much luck, but I must have gotten enough in her to "remind her" how to eat, because she went right over to the canned cat food I had out and started to eat it as quickly as she could (which was not very fast by the way). She ate an entire can. I can't tell you how happy I was! After she ate, she finally got tired. She seemed to have super-feline energy from the time she came home yesterday until she ate, so I was glad that the food finally settled her down. 11/10 Jellica is doing alright. She has been eating - slowly. And, I would like to see her eat more, but it's better than nothing. She is moving around better, too. The e-collar still bothers her, but she's coping. She is a little more grouchy than normal, but she is still purring at night and happy to be snuggled. Have I mentioned that she HATES the antibiotic we have to give her? 11/18 Jellica has been healing up nicely, and yesterday she was even in the mood to play a little. Today was her first radiation treatment. She wasn't allowed to eat after 6:00 am, so I am worried that she didn't get enough food. She was very upset to be in the car again - so upset that she had an accident in the car. That seems to be something she does now when she is stressed. I hate doing this to her. It's a 45 minute trip (one way), so it's a long time for her to be upset. The treatment seemed to go ok otherwise. They had to paint her face a bit with some orange markings, but at least her fur is starting to grow back (emphasis on "starting"). We tried to get food in her as soon as we came home. She ate, but certainly not a day's worth of food. Hopefully, she will adjust to this schedule. Otherwise, she was playful and snuggly tonight. 11/19 Jellica was once again stressed in the car. We got her there just in time for the radiation machine to break down, so she went home without the treatment. They will just tack on one more treatment to the end. It's very disappointing, but I guess this does happen sometimes. An hour and a half in the car for nothing! Ugh! 4/07/2003 I haven't made an update to the diary in months, but I am so happy to report that Jellica is still with us and as feisty as ever! Despite many technical problems, we finally got her through the radiation treatments. Her last one was at the end of the year - Dec 30, 2002. Those weeks were terribly rough. The time commitment was enormous, and Jellica never got any more comfortable with the car. She was always unhappy at the office, so we never stopped wondering whether we were doing the right thing. And, since she was being anesthetized everyday, she went for a long period of time without being herself. That was a scary and difficult time. We were constantly worried about her diet. Occasionally, we were overjoyed by the amount she ate, but those days were rare. Most of the time it was a struggle to find the one thing she would be interested in eating - it was never the same thing twice. At the end of the treatment, she weighed a mere 6 lbs. But, we stuck with the radiation treatments, and she got through it. The radiation oncologist is very happy with her progress. We had three, once a month follow-up visits with the oncologist where they weighed her, took x-rays, and rechecked her jaw. Now, we are taking her to our regular vet once a month for a brief physical, and we will return to the oncologist at the 6-month mark for another full set of x-rays. While the whole process has been very upsetting, horribly expensive, and emotionally exhausting, I am so glad we did it. If nothing else, we have given her a fighting chance. The cancer is something we will always have to watch for, and some part of me will always be expecting it to return. That is a very, very real possibility. But in the meantime, I have my Jellica. Her personality has changed a bit. She is much more of a lap cat than she used to be. The moment I sit down, she is in my lap. She's also not afraid of getting into trouble, either. She'll jump up on the kitchen counter right in front of me. She seems to know that I'll let her get away with just about anything. The fur on her jaw has only grown back about half way, and it is growing in white (it used to be multicolored). She also is unable to groom herself as well as she did previously, but she's still keeping up with herself pretty well - I just brush her every now and then to help her out a bit. She is also still on wet food. And, of course, I am obsessed with how much she is eating, still. She had put on a little over a pound, and then on our last visit, she was down 0.4 lbs. The vet suspects that this was scale variation (the previous time she was weighed was with oncologist - this time it was with the normal vet), but of course we are pretty concerned and trying to get her to eat all the time. I hope this information helps some of you. This process obviously isn't for everyone. Finding a vet who can do the radiation treatment is difficult. We were really lucky to live in a city where this treatment was available. And who knows how long these treatments will last? But, I am very, very thankful that we did it, and I hope she will be with us for many more years! I'll keep you posted! Best of luck to you and your beloved friend!
