Flakes might have cancer - I'm scared and I'm angry

[white shadow]

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Hi jersharocks.

Is it in the right side of his mouth? It looks like his right eye is 'squinty'.

Are you giving him any pain control medication? From his facial expression I'm getting the sense that he's uncomfortable.

And, are you in the States?
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[jersharocks]

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Hi jersharocks.

Is it in the right side of his mouth? It looks like his right eye is 'squinty'.

Are you giving him any pain control medication? From his facial expression I'm getting the sense that he's uncomfortable.

And, are you in the States?
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Yes, right side. He's had problems with his eye on that side for months now. That's the side that had the corneal ulcer and then had uveitis twice. But the swelling didn't show up until a couple weeks ago.

He is getting 2 types of pain medicine right now. He gets Buprenex and Gabapentin each twice a day. Both say 12 hours between doses so I try to spread them out a little bit just to cover more time. The Buprenex is just for the dental surgery recovery but they said we could get as many refills of Gabapentin as we need.

I'm sure he's in pain but I don't know what else I can do. Pain management will be a huge focus of Wednesday's appointment. I do think his facial expression has quite a bit of annoyance as well, he's getting tired of me taking so many pictures.

Yes, I live in Indiana.

 

[Mamanyt1953]

IF you live in an area where there is a university with a veterinary hospital, and if it fits your budget, you might consider that as an option. Teaching hospitals are not always less expensive, but they are teaching cutting-edge medicine, and with the newest diagnostic tools and treatments.

 

[jersharocks]

IF you live in an area where there is a university with a veterinary hospital, and if it fits your budget, you might consider that as an option. Teaching hospitals are not always less expensive, but they are teaching cutting-edge medicine, and with the newest diagnostic tools and treatments.

I did find that we live about 3 hours from the University of Illinois veterinary teaching hospital that apparently has one of the best oncology departments in the country. That's still a pretty far drive though.

 

[Furballsmom]

Call them, or have your vet call them, since Covid may make things more complicated.

 

[jersharocks]

Flakes is doing pretty well today. He hasn't eaten as much but I think he was just turning his nose up at the food we chose for his breakfast because we gave him something different at lunchtime and he ate almost all of it within 5 minutes lol. We've spread out his food into 4 meals for a few years now because he was having a problem where he'd scarf his food and regurgitate it. Splitting it up into smaller meals fixed that problem completely.

I was taking some photos of him while he was up on his cat tree and with the bright light from outside, I noticed that there's some cloudiness on his right eye. It's the same eye that he's had uveitis in multiple times and I'm concerned it's coming back.

There is a veterinary ophthalmologist about 25 minutes away so we may take him there to get that eye checked out. They also have a board certified small animal surgeon on staff so they would probably be a good option for a second opinion on removing this mass as well. We could kill 2 birds with one stone going there.

 

[white shadow]

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Just a quick note - I'd be jumping on the eye issue right away, if I were you, with your competent Vet (not the young no-nothing), to have it nipped in the bud and prevent another flareup. Good on you for catching it now!

I have a few thoughts on pain meds/control too - I'll drop back with those.

Thanks for the pic!
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[jersharocks]

Flakes' eye is looking better today, now I'm wondering if I was just seeing a weird reflection from outside lol. But I'll have the vet check tomorrow either way. There's even less drainage/tearing than the other day.

We took him for a "walk" yesterday morning (put his harness on and let him explore the front yard and driveway). He really enjoyed that. He perked up and was so excited to explore. As soon as we brought him in, he flopped down on our cozy living room rug and snoozed for an hour. He was too pooped to even climb the cat tree haha.

He did have me very concerned yesterday because he wasn't eating much. I think he was protesting me putting the medicine (gabapentin) in his food. It's in powder format so I can mix it with food or mix with water and give it via a (needle-less) syringe. I gave his night dosage to him via the syringe and he did NOT like that. Today I managed to get him to eat it by mixing it with the liquid from a "broth" cat food and then mixing that with a puree style cat treat. He lapped it all up so that might work but I worry that he will eventually figure out that I'm mixing medicine in and refuse to eat that. I'm going to ask the vet about getting it in pill form. I don't care if it costs more, he is super easy to pill with pill pockets and I hate stressing him out with liquid medications. He's one of those cats that just swallows dry food whole so pill pockets are a breeze with him.

 

[Furballsmom]

He really enjoyed that. He perked up and was so excited to explore. As soon as we brought him in, he flopped down on our cozy living room rug and snoozed for an hour. He was too pooped to even climb the cat tree haha.

What a terrific thing to do, I'm so glad to hear he enjoyed his walk so much

 

[Mamanyt1953]

I loved seeing him out and about and enjoying life! Thanks so much for sharing those moments with us!

 

[jersharocks]

We just got back from the vet. Dr. J reviewed his entire chart, did an exam, and then spoke with me over the phone for about 15 minutes. Quick rundown is that basically we're still at possibly cancer but possibly something else.

She spoke with one of the other vets (not the newbie) that was there last week who had seen Flakes (the newbie had asked for his opinion) and he agreed that his swelling has come down quite a bit. Dr. J is thinking that it *could* possibly be an infection in his bone so she wants us to try 3 more weeks of antibiotics. She's also going to order tiny tab gabapentin for us so that we don't have to worry about mixing it in with his food.

She did not see any uveitis in his eye so it may have been a weird reflection or possibly just from the extra drainage he had going on.

She noted that he gained a smidge of weight (0.02lb so less than an ounce but still good because he isn't losing any weight). She wants to see him in about 7-10 days to see how he's doing and see if the swelling comes down anymore.

She did say that she didn't think that surgery was possible given the location. She also said that personally she wouldn't do aggressive cancer treatment for her own cats (she told me about her own cat that had SCC) but she would support us if we wanted to go that route. She said chemo only was essentially useless for this type of cancer and we'd have to go out of town for radiation therapy.

Honestly even though we're still at the same point, I feel a lot better. I'm still concerned that my sweet boy isn't going to be around much longer but I'm hopeful that things might get better soon.

Side note: apparently Flakes was pretty relaxed through the entire exam (I gave him gabapentin 2 hours prior) but he got feisty when Dr. J put him back in his carrier, he is currently annoyed that I keep taking pictures of him and interrupting his look out the window time

 

[jefferd18]

Keep the good news coming for us, Flakes. we are all rooting for you. I have always gotten such a kick out of this cat's expression starting with the avatar photo of him.

 

[Mamanyt1953]

Not "BEST NEWS!" but certainly not worst news ever, either! We're here! Whatever, we're here and rooting for Mr. Grumpy Face!

 

[jersharocks]

We just got back from our follow up with Dr. J. She's pretty sure it's cancer at this point. Swelling hasn't really decreased any more and she said that inside of his mouth looks more swollen.

She did prescribe a chemotherapy drug but she said that she hasn't seen any success using it for squamous cell carcinoma which is what she believes this is. She has seen some success with it for other forms of cancer so there's a chance. She said it's a hail Mary option.

We're going in for another follow up in 10-14 days, he'll need to get bloodwork done then to make sure his white blood cell count isn't too low.

Flakes mostly seems normal still. He has a healthy appetite (he's picky especially about texture of foods but he's eating very well), still fairly active, and he cuddles with either me or my husband every evening while we watch TV. He is getting increasingly agitated at going to the vet so much (lots of hissing at the vet and vet techs) but once he's home, he's perfectly fine. He doesn't cry in the car like he used to though. When I brought him home today he went straight for his breakfast leftovers, ate those and then climbed his cat tree to look out the window.

 

[jefferd18]

We just got back from our follow up with Dr. J. She's pretty sure it's cancer at this point. Swelling hasn't really decreased any more and she said that inside of his mouth looks more swollen.

She did prescribe a chemotherapy drug but she said that she hasn't seen any success using it for squamous cell carcinoma which is what she believes this is. She has seen some success with it for other forms of cancer so there's a chance. She said it's a hail Mary option.

We're going in for another follow up in 10-14 days, he'll need to get bloodwork done then to make sure his white blood cell count isn't too low.

Flakes mostly seems normal still. He has a healthy appetite (he's picky especially about texture of foods but he's eating very well), still fairly active, and he cuddles with either me or my husband every evening while we watch TV. He is getting increasingly agitated at going to the vet so much (lots of hissing at the vet and vet techs) but once he's home, he's perfectly fine. He doesn't cry in the car like he used to though. When I brought him home today he went straight for his breakfast leftovers, ate those and then climbed his cat tree to look out the window.

Thank you for the update. All my prayers are with Flakes and his family. I hope he beats this.

 

[Furballsmom]

He is getting increasingly agitated at going to the vet so much (lots of hissing at the vet and vet techs)

Do you have any calming products you'd be able to use? Only Natural Pet has one called Just Relax, and there's also Gabapentin. You may want to discuss this with it vet if you haven't already

 

[jersharocks]

Do you have any calming products you'd be able to use? Only Natural Pet has one called Just Relax, and there's also Gabapentin. You may want to discuss this with it vet if you haven't already

He takes gabapentin daily for pain. The timing for the last visit didn't work out well for giving him a dose exactly 2 hours ahead of time like we did last time. We give him the gabapentin every 12 hours (7am and 7pm) and his visit was at 10:30am so he had some at 7am but I didn't want to double dose him so I didn't give him any at 8:30am.

We're actually waiting on the vet to call back today because we think his gabapentin dose needs to be increased. Last night and this morning he seems to be in a lot of pain. He doesn't want to eat much (I even offered some kitty milk and he didn't touch that!) and he doesn't want to be bothered. He did walk up the length of our bed this morning after my first alarm went off to try and wake me up so I assume he was hungry but he only ate a few bites and then walked away.

Unfortunately I think we're nearing the end. Yesterday was a good day until the evening. Today hasn't been good so far though.

 

[jersharocks]

Dr. J gave us permission to double his gabapentin dosage. I hope it helps. I can't stand to see him in so much pain.

 

[white shadow]

.
I should have thought of this sooner but, better late than not at all.

I want to give you some reliable information on how veterinary pain control is being managed "lately", because it has changed relatively recently. I'm not advising you to be second-guessing your Vet, just letting you know about the latest 'standard of care' where it comes to pain management.

It used to be that a single pain control med was used, as Flakes is receiving now. This kind of single-agent application is still considered appropriate for certain kinds of pain.

In other situations/conditions, like advancing cancer, it's now common to use a combination of drugs.....because how pain 'works' is better understood, particularly in that there are different pain receptors/'sensors' and different types of drugs can target these receptors. And, as a result, smaller quantities of each drug can be used - which can result in a better quality of life for the patient. As a very simple example, instead of using a very heavy dose of an opioid drug to control severe pain (which would probably cause extreme sedation), two other drugs are added, each targeting different pain pathways.

I've cared for two cats during/through a palliative care/hospice process within the past few years. One, in particular, had a cancer associated with increasing severe pain. We used three drugs, they were adjusted as needed over time, and that cat never knew a tad of pain through to the end. It was only after the disease overtook his breathing ability that we helped him pass. That cat lived life to the fullest until that day. (Likewise, the second cat, happy until 'it was 'time'.)

OK - here's 'the read' for you: Management of Chronic Pain in Cats - TodaysVeterinaryPractice.com

Visually, here's how multi-modal pain management 'works' - one drug from each category:

Honestly, don't wait before approaching your Vet. Even if doubling the Gabapentin better controls the pain, it may result in over-sedating him - and, it most likely won't be effective for very long.

This was the combination of drugs I used:

• Opioid: Buprenorphine, droplets only, applied just inside the lips, it's absorbed by the oral tissue. You were previously using this for dental pain every 12 hours, I believe. It's now been recognized that it's only effective for 6-8 hours - I used it every 6 hours to stay ahead of the pain (much easier than trying to regain control after the cat begins to re-experience it)
• NSAID: Meloxicam, a pleasant oral liquid, a tiny amount is mixed into wet food or swallowed "straight" once a day. The proper 'cat strength' formulation is not available in the US but can be prepared by a compounding pharmacy (such as WedgewoodPharmacy.com) . The only oral NSAID approved/available for cats in the US is only available in tablet form - you probably wouldn't want to have to pill him for obvious reasons.
• The "Adjunct Med" was what you're using, Gabapentin, and was prepared (compounded) into a flavored liquid 'format'.

All 'easy-peasy' for you and the cat....and it allows the cat to comfortably continue an active life until the disease progression itself precludes that.

Some folks might consider this "prolonging life". I can assure you that my two cats had a happy life, right up until we helped them pass. I prolonged nothing..........I enabled their lives to the fullest. That said, we are unique individuals and our preferences and choices will be just as unique.

My suggestion would be to become generally familiar with the content of the article (much is technical, some plain language), forward the link to your Vet and have a discussion with her. Frankly, you won't be giving her information that she won't already know (although the article will prep her for your discussion). Ideally, and in theory, you shouldn't have to insist....but, obviously you'll need to decide how you'll arrange for what you want to do for Flakes. I have no doubt that any well-informed, "current" Vet or Veterinary Oncologist would proceed in this manner. Let her know about this forum and that folks here receive this kind of care for their cats.

If there's anything I've caused a question over, just post back.

The sooner you speak with her though, the sooner you can be prepared to step in when the Gabapentin won't be sufficient.

Hoping that's helpful, and thinking of you. Of course, let us know 'where you're at' with it all.
.

 

[jersharocks]

.
I should have thought of this sooner but, better late than not at all.

I want to give you some reliable information on how veterinary pain control is being managed "lately", because it has changed relatively recently. I'm not advising you to be second-guessing your Vet, just letting you know about the latest 'standard of care' where it comes to pain management.

It used to be that a single pain control med was used, as Flakes is receiving now. This kind of single-agent application is still considered appropriate for certain kinds of pain.

In other situations/conditions, like advancing cancer, it's now common to use a combination of drugs.....because how pain 'works' is better understood, particularly in that there are different pain receptors/'sensors' and different types of drugs can target these receptors. And, as a result, smaller quantities of each drug can be used - which can result in a better quality of life for the patient. As a very simple example, instead of using a very heavy dose of an opioid drug to control severe pain (which would probably cause extreme sedation), two other drugs are added, each targeting different pain pathways.

I've cared for two cats during/through a palliative care/hospice process within the past few years. One, in particular, had a cancer associated with increasing severe pain. We used three drugs, they were adjusted as needed over time, and that cat never knew a tad of pain through to the end. It was only after the disease overtook his breathing ability that we helped him pass. That cat lived life to the fullest until that day. (Likewise, the second cat, happy until 'it was 'time'.)

OK - here's 'the read' for you: Management of Chronic Pain in Cats - TodaysVeterinaryPractice.com

Visually, here's how multi-modal pain management 'works' - one drug from each category:

View attachment 351917​

Honestly, don't wait before approaching your Vet. Even if doubling the Gabapentin better controls the pain, it may result in over-sedating him - and, it most likely won't be effective for very long.

This was the combination of drugs I used:

• Opioid: Buprenorphine, droplets only, applied just inside the lips, it's absorbed by the oral tissue. You were previously using this for dental pain every 12 hours, I believe. It's now been recognized that it's only effective for 6-8 hours - I used it every 6 hours to stay ahead of the pain (much easier than trying to regain control after the cat begins to re-experience it)
• NSAID: Meloxicam, a pleasant oral liquid, a tiny amount is mixed into wet food or swallowed "straight" once a day. The proper 'cat strength' formulation is not available in the US but can be prepared by a compounding pharmacy (such as WedgewoodPharmacy.com) . The only oral NSAID approved/available for cats in the US is only available in tablet form - you probably wouldn't want to have to pill him for obvious reasons.
• The "Adjunct Med" was what you're using, Gabapentin, and was prepared (compounded) into a flavored liquid 'format'.

All 'easy-peasy' for you and the cat....and it allows the cat to comfortably continue an active life until the disease progression itself precludes that.

Some folks might consider this "prolonging life". I can assure you that my two cats had a happy life, right up until we helped them pass. I prolonged nothing..........I enabled their lives to the fullest. That said, we are unique individuals and our preferences and choices will be just as unique.

My suggestion would be to become generally familiar with the content of the article (much is technical, some plain language), forward the link to your Vet and have a discussion with her. Frankly, you won't be giving her information that she won't already know (although the article will prep her for your discussion). Ideally, and in theory, you shouldn't have to insist....but, obviously you'll need to decide how you'll arrange for what you want to do for Flakes. I have no doubt that any well-informed, "current" Vet or Veterinary Oncologist would proceed in this manner. Let her know about this forum and that folks here receive this kind of care for their cats.

If there's anything I've caused a question over, just post back.

The sooner you speak with her though, the sooner you can be prepared to step in when the Gabapentin won't be sufficient.

Hoping that's helpful, and thinking of you. Of course, let us know 'where you're at' with it all.
.

Wow, thank you for all of this! Will definitely give Dr. J a call again tomorrow to see what else we can do. Today is actually her day off but clinic staff called her to get the OK on upping the gabapentin.

I know she had mentioned doing Buprenorphine again but at the time I wasn't sure we needed it (this was weeks ago when he was doing better) and we actually had quite a bit of difficulty with that one despite what you'd expect given that it's a liquid. His mouth is so sore that he does NOT like us messing with it even if we're only touching the other side. He does FAR better with pills in pill pockets. He's always been a "swallow it whole" cat with dry food and treats so pills are a breeze with him as long as they aren't huge.

He has some difficulty getting them into his mouth nowadays but once he does, it's fine. I break up 1 pocket into 3 "treats" with one having the pill and then I "chase" it with the other 2 treats to make sure that it doesn't get stuck in his esophagus and cause problems.

I vaguely remember her mentioning Tramadol as well, I don't know why she didn't prescribe it, though. The only thing I can think of is that he seemed to be doing especially well on the gabapentin alone but you'd think that she'd want to make sure that he wasn't in pain.

It's truly crazy how he went from being fine most of the day to seeming like he's in extreme pain.

For what it's worth, we gave him a second dose of gabapentin right after we got off the phone with the vet's office and he's doing pretty well for now. He spent half an hour following my husband around the house loving on him everywhere he went. Now he's back up in his cat tree taking a nap. When I get off work (I work from home), we're going to take him out for another "walk" and my mom is going to come by for a visit. Flakes used to be her cat before I got married and we adopted him. We wanted to give her a chance to spend some time with him before he passes.