8-Ball's
SCC of the Tongue
(early diagnosis, good results)
8-Ball’s Ordeal
Introduction: 8-Ball was diagnosed with SCC in June, 2003. At the time, he was 13 years old and always very healthy. His weight was always between 13.5 – 14.5#. He is one of 8 cats that are in our household (along with a dog). Several of the other cats in the household are special needs, with problems ranging from heart disease (cardiomyopathy) to intestinal disorders (inflammatory bowel disease) to feline herpes (eye problems). There had never been any type of cancer problems in the household and this became a very frightening time for us. We read up on everything we could on SCC, cancer, cancer treatments, etc. and there was very little that was written that was positive or had positive outcomes.
During the course of this ordeal, it became apparent that a lot of the problems people face who have animals with SCC or other cancers is the availability of Veterinary Specialists in their area, the cost of treatments, and the time commitment involved. I feel lucky that the availability of Vet Specialists in my town (Tucson, Arizona) are plentiful and include some of the best vet specialists in the country, and that I had a wonderful boss who allowed me the time to care for 8-Ball and to also bring him to work with me when needed…also, my view is that I would go to all lengths to care for my animals…which, ultimately, included max’ing out a couple of credit cards. But, I can guarantee anyone – I would do the exact same thing again – even if 8-Ball’s outcome had been less positive. Going through this ordeal with 8-Ball showed me the courage and survival instincts of animals and made me realize how special they are (I thought I had known how special they were before!!).
It is now March 16, 2005 and 8-Ball is doing wonderfully. He is a strong 14#, 10 oz. and “runs” the household! Even though he and I were close before his ordeal, during the last couple of years he and I have become even closer. This is one of the most wonderful feelings in the world.
Below is a summary of 8-Ball’s ordeal, with the first several weeks discussed in detail.
June 21, 2003:Yearly exam at vet. Discovered lesions under tongue and began antibiotics and Prednisone for 1 week to see if the lesions were due to an infection or bug bite (taught me to make sure Vet checks under tongue whenever there is a check-up…).
June 27, 2003:Lesions still there and a little larger. Biopsy scheduled for 6/30/03.
June 30, 2003: Biopsy under general anesthesia.
July 2, 2003: Biopsy results shows SCC. There are 2 Veterinarian Oncologists in Tucson. Called and made emergency appt. for July 3.
July 3, 2003: Met with Oncologist. She was optimistic because the tumor wasn’t huge yet but was concerned about the location of the tumor (on the underside of the tongue). She explained the options and said the best process was surgery, radiation (of the neck and jaw) and a low dose of chemotherapy. Discussed that the radiation treatments would be 16 treatments, every day of the week for 16 straight days after the surgery (excluding Saturdays and Sundays). Chemotherapy would be given initially to sensitize the cells for radiation and then occasionally (if his white blood cells would allow for it). The only side effect I should see is that [for the radiation] the hair would need to be shaved from
8-Ball’s neck and jaw and when it grew back in, it would be grey/white because radiation kills the cells that make the color of the fur (8-Ball was pure black with 6-7 white hairs on his chest).
July 8, 2003: Met with surgeon, who is one of the few surgeons in the U.S.A. who uses laser surgery (much less invasive than regular surgery). She explained the surgery (which would be done today) and then discussed that they will begin radiation treatments today after the surgery is completed. She was optimistic also but was also worried about the location of the tumor.
After surgery, met with Oncologist and Surgeon. Surgery went well and they would begin chemotherapy tomorrow to sensitize the cells for the upcoming additional radiation. They will also evaluate to possibly place a feeding tube in 8-Ball’s stomach because the surgery and subsequent radiation will most likely keep him from wanting to use his mouth to eat.
July 9, 2003: Chemo and radiation treatment. Feeding tube was inserted and 8-Ball had to spend the night at the hospital because they had to make sure no infection resulted from new feeding tube. Oncologist also stated that 8-Ball’s blood panel showed his blood sugar to be very high – possible diabetes (8-Ball’s blood sugar had never been high in previous blood panels). I discussed this with my regular Vet and the Oncologist and they both stated that we need to watch this carefully – diabetes can be triggered by Prednisone (which 8-Ball had been on for 1 week during initial evaluation after finding the tumor). This could be “transient” diabetes and go away in 3-6 months, or could become permanent.
July 10, 2003: Picked up 8-Ball late in day. He was running a slight fever due to everything he’d been through the past couple of days. I received instructions on his feeding tube. He had a “sweater” on to keep his feeding tube in place. Received some additional medications (pain killer and antibiotic) and was shown how to give these through the feeding tube also.
July 11, 2003: 8-Ball received 2nd chemo treatment. Almost 100% feeding through stomach tube since his mouth is very sore. Since he is a 13-14# cat (although he had lost a couple of pounds during this entire ordeal), I feed him 4 times each day with 90 ml at a time (fed Science Diet AD at the beginning but this was very rich – so, began mixture of AD and ID after a few days).
July 12, 2003: Began small dose of insulin by injection to combat high blood sugar. Received instructions on how to give insulin – relatively easy to do.
July 14, 2003: Resume radiation treatments. My boss at work allows me to bring 8-Ball into the office with me after radiation. I drop 8-Ball off for radiation at 7a in the morning and am able to pick him up around 12noon. Then, he spends the rest of the afternoon in my office, with the 2nd of the 4 feedings through his stomach tube around 1p (we continue this regimen throughout the remainder of the 16 radiation treatments).
July 16, 2003: 8-Ball’s mouth pain is worse so he receives a pain patch. This is a 3-day patch and will need to be changed every 3-days (by the Vet). Was instructed to make sure I give extra water through his feeding tube since he has stopped drinking on his own.
July 17, 2003: CBC showed 8-Ball’s white blood count was very low – cannot continue chemotherapy at this time. Was still running slight fever also – continue antibiotics (obtained them in liquid form through the Compounding Pharmacy so I can put them in his feeding tube).
July 20, 2003: Although still in a lot of pain (pain patch is helping), seems to be getting used to the feeding tube. Seems to get hungry and comes and gets me when he wants to eat. Purrs when I put food in through feeding tube.
July 22, 2003: Another CBC was run – white count still low. Cannot continue with chemotherapy. Therefore, his regimen will only consist of radiation treatments.
July 29, 2003: Last day of radiation treatment. Now it is a “wait and see” approach. I scheduled an appointment for every 2 weeks with the surgeon who conducted the surgery to evaluate 8-Ball’s mouth for any recurrence of the cancer. This was suggested by my regular veterinarian (who works closely with the surgeon) because if the cancer recurred, they didn’t want to lose any time by having 8-Ball first see the regular vet and then have to be scheduled into an appointment with the surgeon…The Oncologist said that they did not need to see 8-Ball again unless there were “new” cancers involved in other places. They told me that the animal can only go through the radiation treatments once because of the intensity of the treatments.
8-Ball’s feeding tube would be left in for another 1-2 weeks until he felt well enough to eat on his own. We would start offering him food orally and until he was back up to full strength, any oral feeding would be supplemented through his feeding tube.
8-Ball would continue to be evaluated for his diabetes with my regular veterinarian.
Mid-August, 2003: 8-Ball was eating on his own and his feeding tube was taken out! All was well so far with his mouth – it was healing well.
End of August, 2003: 8-Ball seemed uncomfortable in his abdomen. After several trips to the vet, an endoscopy was conducted to identify if any problems had occurred in his abdominal area. It was discovered that there was part of his feeding tube left in his abdomen! Emergency stomach surgery was scheduled for the next day with the surgeon who had originally conducted 8-Ball’s mouth surgery. It turned out that 2 large pieces of the feeding tube had been left in his stomach after the feeding tube was pulled out….this had caused some small ulcers in his stomach – but, no permanent damage.
Mid-September, 2003: During one of the regular 2-week check-ups, a small spot was identified by the surgeon near 8-Ball’s previous cancer. The surgeon immediately “zapped it” with the laser.
Early-October, 2003: A larger spot was identified by the surgeon near 8-Ball’s previous cancer. The surgeon scheduled a more in-depth surgery for the next day.
After surgery the next day, the surgeon was a little distraught and stated she had to cut (with the laser) much deeper than anticipated because the “spot” she had seen was larger than the naked eye could see and was deep into his tongue. She was worried because she had to cut into the tongue in spots where the blood supplied the tongue. She was also worried because she felt the SCC (cancer) had returned aggressively – the “tumor” she cut out today was large and she sent it out for biopsy.
8-Ball was uncomfortable after this procedure and was on heavy pain medication (oral, not the patch). I syringe-fed him since he no longer had the feeding tube and would not eat on his own.
The biopsy result came back 2 days later – the surgeon called and stated that the tumor was NOT cancer! She stated that it was something that was seen occasionally and may have been exacerbated by 8-Ball’s current diabetic state (which was still not under control). She stated that the tumor was actually a thing called a “rodent ulcer” (layman’s terms – I can’t spell the medical term) and she was actually glad that she had dug as deep as she had to get the tumor out because she was told by the lab that if there were even minute parts of the rodent ulcer left, it would undoubtedly recur. I found out that rodent ulcers can grow quite large and obstruct an animals ability to eat….
We continued for the next few days to watch 8-Ball’s tongue and its ability to heal. Things were not looking very good, however, because the front part of his tongue was getting grey and ugly. Unfortunately, the tongue tissue around the area in which the blood supply had been damaged was irreversibly damaged. I took 8-Ball into the surgeon, who sadly told me that the entire front 1/3 portion of 8-Ball’s tongue was “dead and rotting.” (I was still syringe feeding him at this time). A decision was made to remove the front 1/3 of his tongue immediately. It would again be a “wait and see” to see if he could adapt since cats use their tongues for everything (grooming, eating, drinking, etc.).
For the next several weeks, I watched 8-Ball as he tried to adapt. I continued to syringe feed him during this process. The surgeon had told me that most animals can never adapt to this type of disability (especially at the age of 13 ½ years old) and that I should prepare myself for a possible negative outcome. However, what amazed me was 8-Ball’s continual effort to try to do the things he previously had done. Gradually, he learned how to groom himself by using his teeth and the tiny bit of tongue that he could push out to touch his paw. He learned to eat small pieces of dry and semi-moist food by throwing them back into his throat. He learned to “smash” his face into canned food and eat some canned food (although, I had to wipe his face off after he was done because it was all full of the food!). However, he could never eat enough to sustain him – which was a bit frustrating for him. He also could not get enough water into him because he didn’t have enough of a tongue to lap up the liquid.
Current:
Since that time, late October/early November 2003 to the present, 8-Ball receives 99% of his nutrition through syringe feeding twice a day. He still has diabetes that is currently under control, with insulin injections 2x per day (morning and evening) along with his feedings. The fact that he has to be syringe fed is absolutely no problem whatsoever and it allows him and I to share important times together. Since he is diabetic, the syringe feeding is actually quite easy because he is fed a diabetic diet that is blended in the blender along with ½ jar of chicken baby food and a little water for each day’s diet. He is also syringe-fed water during each of his feedings and periodically throughout the day and before bed. 8-Ball knows the times of his feedings (which have to be on a particular set schedule daily due to his insulin injection schedule needing to be strict) and he stands on his “feeding mat” (a certain floor mat) when he knows it is time to eat. He purrs when I feed him and opens his mouth for every syringeful of food and water. He receives snacks 1-2 times per day (when he yells for them), which are a couple of morsels of dry or semi-moist food that he tries (and usually succeeds!) to nibble at.
8-Ball kept going to the surgeon for a check-up every month for a full year after the front of his tongue was removed (through November, 2004) and he has not had any recurrence of either the cancer or the rodent ulcers. Now, almost 2 years from the time of the initial finding of SCC, he now is seen only by his regular vet (usually once a month) to evaluate his blood sugar level – at which time, she always looks in his mouth. 8-Ball has maintained his weight – he is a healthy 14#, 10oz., and, due to the high-protein diabetic diet he is on, his fur coat is shiny and thick. He does a terrific job grooming himself, but he also gets “help” from me with grooming towels every month or so as well as a daily brushing. He is “King” of the house, keeping all the other cats as well as the 45# dog in order! For Christmas, 2004, a friend of mine gave me a close-up picture of 8-Ball sitting proud and tall – she titled the framed picture “My Hero” – which is true in every sense of the word. 8-Ball has taught me so much about perseverance and pure survival. If I had to do it over again, I wouldn’t change a thing….
