Personal experience with feline squamous cell carcinoma of the tongue
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My personal experience with Snoop's squamous cell carcinoma of the tongue
(compiled Oct 3, 2001) |
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Be advised, there is not a happy ending to this story. However, each case is different. Perhaps you will have a happier outcome with your pet.
A note about notes I have highlighted some text that I hope will be more helpful to you. These sections begin with A note about... and are in bold, underline. Topics include biopsy, syringe feeding, food, eating and drinking, my rating system, the end, phone numbers.
Some background on Snoop: Snoop was 12 years old when the first symptoms of cancer appeared. She was an indoor cat with accompanied visits to the backyard during the summer months. She received regular exams every year and the recommended vaccinations for Rabies, FeLV, etc.
As for the cancer treatment process, it is very stressful. I, fortunately, was working out of my home most of this time and could monitor the situation closely. I knew this cancer was not curable, and with Snoop's quality of life being the prime objective, I realized that surgery to the tongue area would not be an option--it was high risk if not impossible and a positive outcome was unlikely. Basically it was inoperable and incurable and I refused to put Snoop through such an invasive procedure with such a poor probability for success.
Knowing what I would have to do to Snoop one day, i.e. euthanasia, made for a very sad and stressful summer. Fortunately, I had very caring veterinarians and supporting office staff. They were always available for questions and would call me to check on Snoop's condition. Now if I could just find a personal physician who was at least half as caring!
Here, then, is the sequence of events with some expansion on key topics. I hope this helps in the treatment of your pet.
A couple of weeks prior to May 22, 2001
Snoop began showing signs of what appeared to be skin irritation. She began to bite at her fur. The tummy area fur was mowed down almost to the skin. Snoop failed to groom her fur normally and the fine chest fur was clumping. I suspected an allergy may exist and made an appointment with a cats-only vet 100 miles from home.
May 22, 2001 (initial vet visit--cancer suspected)
We visited the cat vet and I explained the above symptoms. She said that the fur is often an indicator of something more serious. She performed a routine examination and discovered what she believed to be a cancer under the tongue. It was indicated by a mildly irritated area with a slightly irregular texture where the tongue attaches to the bottom of the mouth. She took blood for a complete blood count (CBC). Expecting to hear that it was an allergy and learning it could likely be cancer was a huge shock. The vet suggested we watch it for a couple of weeks. The blood results showed no problems other than a slightly low white blood count. The CBC came back pretty normal which was actually bad news because it meant that cancer was more likely the problem.
June 7, 2001(cancer confirmed)
The first sign that something had changed was when I noticed a small amount of drool where Snoop had been sleeping. I also noticed that Snoop began to drop her hard food occasionally when eating and she began to reject her 2 tablespoons of milk she enjoyed each day. Otherwise there were no visible symptoms. I contacted the vet for a second appointment and she said she would also arrange for a second opinion.
June 13, 2001(biopsy of tongue)
This next vet visit and second opinion appeared to confirm that the problem was most certainly cancer, probably squamous cell. The vet, using his cell phone from the exam room, immediately called a vet specialist in oncology and arranged for an emergency visit the same day. I then visited the oncologist and, after an exam and discussion, where I stressed that Snoop's quality of life was the highest priority, and understanding that the only way to be certain of the exact problem and thus the correct treatment, was to perform a biopsy, I elected to have this done.
A note about the biopsy
The biopsy would take a few small plugs from the affected area under the tongue. A general anesthetic would be used but I was told the new anesthetics would not make Snoop feel lousy as the older ones did and an overnight stay was not required. I would leave her for 4 hours. In anticipation of this possible diagnosis, I did some preliminary research and read that Carboplatin had been used effectively as a chemo drug. However, I was informed by the oncologist that an additional (fairly costly) test called a Chemo Assay, would test the cancer cells against many different possible chemo drugs to determine which drug would be most effective. My response was, "if I'm going to put poison into Snoop I at least want it to be the right one. So do the assay." It was not an easy decision to have a biopsy performed because I suspected it would be pretty painful but my research prior to this visit indicated that this was the only way to know exactly what we were up against. Total cost $600 (including the assay cost of $250). The oncologist said Snoop would recover fairly quickly, in a few days. I found it to be closer to a week with some complications. See June 15, 16 top
June 15, 2001(started painkiller usage)
Snoop slept most of the two days following the biopsy and had no interest in eating or drinking. I contacted the cat vet and was told she could be in some pain. I was prescribed Butorphanol (1/2 mg, 2 times per day for a 10lb cat) in a trans-dermal creme. I obtained this from The Animal Pharmacy in Canandaigua, NY (phone is at bottom of this page). The creme is applied twice daily by rubbing a small, carefully measured amount onto the inside of Snoop's ear. I preferred the creme over pills (not easily administered to a cat with mouth discomfort) and a trans-dermal patch (patch area needed to be shaved and new patch applied every 3 days. I live 100 miles from the vet so this was not convenient). The creme was very easy to apply but I can say that it was difficult to determine if Snoop was actually in pain. I elected to be cautious and to avoid discomfort for my buddy. The cost of the creme was $85 per month. It was difficult to determine if the cancer was causing pain so once I started using the creme I continued every twelve hours without interruption until Snoop was put to rest.
June 16, 2001(emergency vet visit)
Almost three days since the biopsy and Snoop still was not interested in food or water. I contacted my cat vet and arranged for an emergency visit the same day. Fortunately, neither Snoop nor I had objection to car travel, so, back to Rochester. The cat vet administered water sub-cutaneous, and included an antibiotic as a precaution against possible, but unlikely, infection to the biopsied area. A prescription for an antibiotic was also prescribed: Antirobe. He (one cat vet was "he" the other "she") then demonstrated manual feeding of Snoop with a syringe and coached me on a trial run. This instruction was of more significance than first expected--I would discover the need to do this on several occasions in the following months. The vet warned me that if Snoop were to go more than 3-4 days without food or water it would be a serious situation.
A note about syringe feeding
Here is the manual feeding procedure that I used:
1. Mix Science Diet A/D (canned food for ailing cats) with water to form a slurry, about the consistency of a milkshake.
2. Using a 10ml syringe, suck the slurry up into the syringe while rapidly moving the tip in the slurry in order to avoid air pockets in the syringe.
3. Grab the pussy cat by the scruff of the neck, gently but firmly if necessary. Snoop required only a very light grip.
4. Put the tip of the syringe in the back corner of the mouth and inject a small amount towards the back of the throat, aft of the high part of the tongue. About 1/5 of the syringe with each squirt.
5. Remove the syringe after each small squirt and allow the cat to swallow. Do this a few times and allow the cat to rest a few moments.
6. I was told to administer a minimum of 6 full syringes, 2 times a day. This amounted to about 1/3 to 1/2 of a can of the A/D.
I performed this procedure for three days and Snoop began to eat her solid food again. But there were some complications here too. See June 19. top
June 19, 2001(food type changed)
Snoop lost interest in her solid food following the biopsy. In an attempt to get Snoop eating solid food again, I tried changing to a different brand. She will only eat dry food and she normally had a vigorous appetite. Her regular food of choice was Science Diet Light Hairball formula but she stopped eating this, for a while, following the biopsy. I tried several other foods to get her attention and finally found Iams Adult formula did the trick. However, I was so thrilled that she was eating again I gave her too much without allowing her body to adapt to the new food and she got diarrhea. This passed (literally) and by June 22 she was eating well again and with normal bowel movements In fact, she looked quite good and was playful again. So the biopsy became a week-long ordeal.
A note about food
I would like to elaborate on the whole food issue. I think it is one of the key messages I hope to make with this dialogue. It was one of the greatest challenges I faced. I have always fed Snoop at regular times of the day; prior to this ordeal I did not leave food available to her at all times. Basically, she loved to eat, she was a pig in fact. This caused weight problems early in her life so I resorted to measured amounts three times daily. 7AM, 5PM, 11PM.
During her cancer she would go for a week or two and then become disinterested in her food. Or, she would find the shape of the food difficult to control with her mouth/tongue. As I mentioned, her regular food prior to the cancer was Science Diet Light Hairball formula. This is a fairly large food, about the size of the end of your pinky finger (most peoples pinky finger anyway). This was easy for her to pick up and required only a single crunch to consume. When she began to reject this I switched to Iams Adult formula, after trying a few others with no success. This food is slightly smaller than a pencil eraser and she enjoyed it for about a week. She was never interested in the softer hard foods. After she lost interest in the Iams Adult I found she was interested in Science Diet Senior Hairball. Again, she seemed to find the larger size easier to manipulate. Also, the Senior formula has more smell and, because of her limited intake, the Senior formula with more fat and calories seemed a better choice. Later I found Meow Mix to be the trick. When switching food try to do so over a 4-5 day period by slowly increasing the amount of the new food while decreasing the old. This will prevent the diarrhea.
I also began to take canned Albacore Tuna fish and liquify it in the blender, along with a little added wter. I did this also with canned chicken. I provided this to her in a saucer and occasionally by syringe and Snoop enjoyed this immensely but, as with other foods, somedays it worked and other days it wouldn't. I stored the liquified foods refridgerated in Tupperware containers. My whole point here is to make you aware that, if your cat gives up on one food, try another. It's not easy. I also provided catnip to brighten her spirits. Pounce was used also and is high in fat and calories. It worked now and then and Snoop preferred the hairball Pounce even though I tried several others. I suggest buying food in the smallest quantity possible.
At times, I used a high calorie and nutrition supplement called Nutri-Cal. This is available from the vet. The instructions say to apply to the paw and allow the cat to lick the supplement into the mouth. Snoop was not interested in doing much licking so I resorted to diluting the Nutri-Cal and syringe-feeding Snoop. I needed Nutri-Cal only during Snoop's final few weeks.
One final note on food. Expecting that Snoop would go through some periods of reduced appetite, I began feeding her as much as she wanted and kept food out at all times, monitoring the amount to be sure she was eating. I attempted to increase her weight in anticipation of coming events. I managed to increase her weight by 1 pound (about 8%) prior to her first chemo. During the days immediately following the chemo she lost this pound and was back to her normal weight. top
A note about eating and drinking
Snoop's eating and drinking became two of the most time-consuming events for me to monitor. By monitoring her litterbox deposits this task became much easier. My suggestion is to use clumping cat litter and each day remove the deposits. It will be easy to see if your cat is eating and drinking on a regular basis. During most of the summer I would expect to find 2-3 urine deposits in the box each day. Towards the final days this became 1 every two days, and eventually almost none. In the final week, after attempts with the syringe, I realized that sufficient water would require either a feeding tube or reqular sub-cutaneous injections. Both of these exceeded the quality-of-life standard I had set for Snoop. Unfortunately, only you can make this decision for your pet. It is a painfully difficult decision. top
June 25, 2001 (first chemo treatment)
The Chemo Assay indicated that one of the common drugs, carboplatin, would not be very effective but there was another drug that should be quite effective. (I will not mention that drug because it is irrelevant. Use the findings of your own Chemo Assay). The drug used for Snoop's chemo did not require a general anesthetic--it was injected via a catheter into the front leg. Total time for the chemo treatment visit was about 45 minutes. The chemo treatment would need to be repeated every 3-4 weeks.
June 29, 2001 (eating normally again)
For four days following the first chemo Snoop again lost interest in eating although she seemed to be drinking. She seemed fine otherwise, but was a little tired. I called the cat vet and was prescribed an appetite enhancer, Cyproheptadine, 2mg, twice daily. Within 8 hours of the first dosage Snoop was back to eating normally. This was, in my opinion, due to a combination of the time since the chemo and the appetite enhancing drug itself. Cost was $10 for a 20 day supply. I used it from time-to-time to boost her appetite.
July 3, 2001 (complete blood count)
One week following each chemo a complete blood count (CBC) was required to make sure the white blood count was not pushed too low as to allow infection. At least that is the way I understood it. This required a quick visit to a local vet and, of course and unfortunately, another poke in the arm for Snoop. During this week she had a lowered appetite but seemed to be enjoying herself. If she did not eat much I would feed her for a day or two using the syringe method. Actually, at the time, I thought this may be Snoop's final week. She seemed less interested in eating but still enjoyed going outside. I began to leave the door open all day as I knew she would not go far. She had a normal routine: walk to the woods 50 feet away, eat some grass, walk to the other woods, another 50 feet, eat some more grass, return to the house, final 50 feet of the triangle. I also began rating her condition and kept a record.
A note about my rating system
I found it was becoming more difficult to keep track of Snoop's deteriorization. It seemed like the bad days were what I remembered most, even thought they were in a considerable minority. Most days she acted and appeared to feel fine. So I began to rate her each day on a scale of 1-8. I used 8 because I felt 10 was a perfect, no-cancer condition. For example, July 4th I rated her overall condition a 5, yet July 5th-7th I rated her condition an 8. Most days in July were 7-8. If she got down to a 3 for more than a few days I would expect to have to consider the end being near. I did not see her in a condition this low until early September when she quickly went from 4-5 down to about 1-2. top
July 19, 2001 (second chemo)
This second chemo treatment went without a hitch. In fact, she came home and went outside. Snoop acted normally, looked good, ate well. The oncologist prescribed Metoclopramide to ease the impact of the chemo and to maintain her appetite. I do not know if this is for all types of chemo treatment or only for the particular drug Snoop received.
July 23, 2001 (small amount of bleeding)
I noticed, for the first time, a small amount of blood from the mouth following a vigorous eating session. The oncologist told me that there was probably no additional pain due to the bleeding. What I seemed to notice was that Snoop ate better in the days immediately following a bleeding session. Perhaps some pressure was relieved. I don't know.
July 30, 2001 (second CBC and grooming)
During the past couple of weeks Snoop's grooming became virtually nil. Her fur also lost that fresh, clean scent that cats have after they groom themselves. On this visit to the vet for her CBC I also requested that her clumped fur be trimmed out and that other areas near her hind end be trimmed of the long fur since this frequently containted remnants of her use of the litterbox. The cat groomer, however, was able to use a special grooming comb to comb out the clumbs. Her tailfeathers were trimmed as were some other very clumbed areas. She was also given a dry bath using a spray cat cleaner. As time progressed, it became more and more difficult to keep Snoop smelling good. Apparently, her saliva was not able to keep her clean and perhaps contributed to the disagreeable odor. At times I would bath the lower half of her with water and cat shampoo, leaving her back dry. If you do this, pick a warm day or use a hairdryer at about 18 inches to dry your cat. During this week Snoop was looking and feeling so good that we took a trip to visit relatives 500 miles away. Snoop enjoyed the trip and was alert.
August 10, 2001 (more bleeding)
Sad day. Snoop sat by her water dish with a very bloody mouth. The vet advised me that it probably looked worse than it was. A little blood can look like a lot. I found this to probably be true. It was probably not more than a total of 1/2 teaspoon and it stopped quickly. This bleeding occurred from this point forward about every 3-5 days. Snoop did not appear in any pain and acted fairly normally, but her condition I began rating in the 5-6 range.
August 20, 2001 (third chemo cancelled)
Snoop began having much more difficulty eating and her mouth looked worse. This combined with the bleeding sessions, increased sleeping, and an overall degradation in her condition, I elected to cancel her third chemo treatement scheduled for this day. I did this after talking with the oncologist and discussing Snoop's condition. I think we had hoped the chemo would keep Snoop's quality of life high for perhaps six months but the chemo did not appear to be slowing the disease to the desired degree. Realizing that her time was growing short I decided not to put her through the stress and discomfort of another chemo treatment.
During this week Snoop's mouth continued to look worse and she ate very little. Her condition was, at best, a 5. I scheduled an appointment to have Snoop put to rest for August 25th.
August 25, 2001 (vet cancelled)
Snoop felt good this morning and purred in response to my petting for perhaps 2 hours. She then slept all day. Based on her sudden burst of life, I cancelled the vet appointment. It was not yet time. Rescheduled the vet visit for August 28th.
A note about the end
I was told by several people that I would know when it was time to put Snoop to rest. "Snoop will tell you" they would say. Well, I can tell you that she did, but it wasn't as clear cut as I had hoped. It's a fine line between "not there yet" and "waiting too long". The decision of "when" becomes very clouded from a strong desire to keep the loved one alive versus putting the pet through the unnecessary agony of slow starvation and dehydration, not to mention the possible pain caused by the cancer in such a sensitive area. It becomes a day-to-day analysis of the situation. top
August 28, 2001 (not yet time)
Snoop not eating or drinking much and I needed to supplement her food intake with syringe feeding. She seems to be in reasonable spirits and spends most of her time sleeping on the chase lounge in the backyard. Not much activity but she did spend a few minutes searching the logpile for a toad she saw there last week. Again postponed the vet's housecall. Snoop's condition: about 3-4.
September 1, 2001 (postponed again)
The cat vet was scheduled to make a house call to put Snoop to rest today but it's just not quite time, at least it's not time for me. I'm not ready to let her go. We are at that point where a razors edge divides the "not yet" from the "too long". I rescheduled the vet's visit for September 3rd.
September 2, 2001 (update)
I am watching Snoop very closely to be certain of my decision for tomorrow. But there is no doubt. Her spirit is pretty much gone and she sleeps constantly. She has lost at least a couple of pounds in the past week and makes no deposits in the litterbox, despite the food and water I try to feed her. She rejects the syringe feeding and is weak and can jump up on the couch only with difficulty.
September 3, 2001 (it's time)
The vet arrived at 1:45. Snoop went quickly while lying in my arms on the chase lounge in the backyard. There's nothing to be gained from telling the details other than this: the vet first administers a quick, painless shot that puts the cat into a euphoric state. This is a good time to hold, pet, and talk normally to your friend. The final injection is to a vein in the leg and death is almost immediate, within seconds, almost too fast.
Snoop was dehydrated and the vet had to try several legs in order to find a vein that would take the injection. I've read that it is best to hold your emotions until afterwards so as not to alarm the pet. It may sound impossible to hold back the emotion but when you know it's in the best interest of your much-loved pet you will be able to do it. Really. It was the saddest day of my life and the emotion flowed immediately as I felt the life and personality evaporate so quickly and permanently.
Aftermath
When I look back on the past few months I feel I can honestly say I did everything the best I could and I would have done nothing differently. This, remember, is based on the best knowledge available to me at the time. I feel that seeking out, or luckily chancing upon the right doctors will benefit you greatly. I was lucky in this regard and feel I had the best care possible for Snoop. I could not let Snoop go without providing this level of care--for me there was no other option. These few months also gave me time to adjust to the fact that Snoop would no longer be with me.
As I mentioned earlier, Snoop's quality of life was the main objective. If Snoop appeared content, was interested in doing "cat" things, and did not appear to be in pain, then I felt I was satisfying this objective. Advice from my vets regarding the behavior of ailing cats was also helpful in deciding how long I should continue care and treatment.
I elected to have Snoop cremated. She was cremated as an individual and I've placed her cremains in a small cedar chest which, for now, has found a home on my bookshelf.
I was lucky to have a vet who comforted me; in fact I had two of them. They were available virtually anytime and in the end, when I wished for Snoop to be put to rest in her own backyard, my vet made a 200-mile round-trip house call on Labor Day. You can't ask for more than that.
Please consider a donation to your favorite pet charity or animal shelter in the name of your pet.
Finally, I must mention that there are a surprising number of caring and understanding people, many of whom have gone through this with their own pet. All of my friends know how important Snoop was to me and all have been very understanding. To all of these friends and acquaintances I forward my warmest gratitude.
The End
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My cat vet: Cats Exclusively, Pittsford, NY 585-248-9590
Oncologist: Veterinary Specialists of Rochester (NY) 585-424-1260 by referral
Pharmacy: Animal Pharmacy, Canandaigua, NY 585-394-4930 or toll free 877-501-8001 |
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