| |
| |
My
personal experience with Snoop's squamous cell carcinoma
of the tongue
(compiled Oct 3, 2001) |
|
| |
| |
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
top
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 |
|
|
