Stitches out

Castiel got his stitches out Wednesday and is very happy to be able to groom himself again and not wear the onesies. We can also let his sister Clover snuggle with him without close observation. We were afraid she would groom him or try to remove his stitches for him. Clover was a holy terror about stitches after her spay.

We were a little concerned the day after we removed his stitches because Thursday morning he was hiding in the leopard house (a rectangular cat house with leopard patterned fabric.). He usually only goes in there on cold nights as it’s a very snuggy house. It was warm that morning and the sun was shining though the window, so usually he would seek out a sunny spot. My husband gently picked up the house and we emptied him out of it to check on him, in case there was a sore spot or something had opened up — but everything was fine  and Castiel seemed fine, just anxious. We think he was afraid he was going to be scooped up and taken to the vet again. It was Veterans’ Day and we had slept in later so breakfast was later. The change is routine probably got him thinking vet.

Castiel has been doing great walking around. He can get to all his favorite spots and the ramps and steps help. He can even do the stairs, which we try to get him not to do as we worry it’s just a little too soon. He hasn’t got up on the cat tree yet but I think that is because it is in a room without carpet so it’s a little tougher to navigate the hardwood. We’re going to pick up a runner at the shops so he can easily get to the cat tree and best window for squirrel and possum watching.

Castiel has been a little anxious and jumpy. We think he just needs some time to relax at home and have some normal time. He doesn’t seem to be in pain, just scared that we’ll go to the vet again. We put the furniture back to normal and are giving him freedom to roam without us  hanging directly over him. He is also allowed to freely interact with his siblings again and I think he likes that. Now if we could only get his tiger sister (Clover) to stop lying across his ramps.

We’re still trying to decide whether to do radiation or close monitoring every 1-2 months at our vet. We don’t think Castiel would do well with the 5 x a week radiation for three weeks, so we are steering away from that.  He gets so stressed travelling and we worry about the anesthesia. Also we don’t know if it’s necessary.  There is no evidence it is a vaccine associated sarcoma — it still could be, but we don’t know this for certain (none of the usual indicators were present, but the absence of the indicators is not definitive). The margins were clear but the top margin was only 1.5 cm, not as good as 3-5 cm, which is ideal. Removing the leg may have been enough…we just don’t know. One oncologist who saw him before surgery advocated for radiation and chemo as general treatments for fibrosarcomas, the second oncologist said we could do radiation if we wanted to treat it aggressively but didn’t strongly recommend it. The radiation oncologist recommended SRT but said it would depend on the CT scan. He was in favor of radiation though but said he would understand if we wanted to do close monitoring. Our local vet deferred to the oncologist as the most knowledgeable but said she wouldn’t recommend it for Castiel and she knows Castiel well. Our vet friend, who saw Castiel as a kitty, also wouldn’t recommend radiation.  The risk of reoccurrence is low but not zero. But our local vet and our vet friend both think quality of life and what Castiel would want should be important considerations in our decision-making, and it is hard to disagree with that logic.  If it does come back, we may be able to treat it with radiation then, although the radiation oncologist warned it might be harder. It’s an impossible decision…the humans are very stressed. We thank everyone who has listened to us, followed our progress, and has weighed in with tips, advice, or just with kind words to let us know we are not alone. Thank you so much!

Castiel relaxing on the sofa with his hoomans

 

 

 

 

 

 

Radiation Oncology Consult

We have no idea what to do.  It’s not even 8 pm and my husband has gone to bed. We can’t take the stress.  No one is eating dinner again. The laundry from the weekend is still in the dryer growing mildew.  We’re depressed, we’re miserable, and we don’t know what the right decision is and neither do the experts. We just want our little panther to be healthy and well and live a good long life.

We had a consult today with a radiation oncologist at SAGE about whether to do adjuvant radiation therapy; and if so, what type. The oncologist yesterday said that if it’s a vaccine associated sarcoma (VAS) we should do the radiation therapy. If it’s not a VAS then we probably don’t need the radiation.  The oncologist said there is no way of knowing which it is. We’ve had two tests that don’t show markers of a VAS but apparently these tests are not definitive. The location makes the doctors suspicious that it’s a VAS. No record of vaccines in that spot but he could have had a vaccine there before we adopted him at 6 months. However, the literature suggests a VAS would show up probably sooner but maybe not until 10 years later.  My husband spoke with the oncologist yesterday because I had to go into work. He said he thought she was leaning against radiation, although she was careful to sound neutral.

The doctor today recommended radiation but it wasn’t a strong recommendation. He is concerned that the tumor seemed aggressive. From the time we noticed it and the time we did the first surgery, it grew fast. It was a grade II – intermediate. The margins on the amputation were 1.5 cm, if they had been 3-5, he probably would have been less likely to recommend radiation. He thought the chance of reoccurrence was around 20 percent which sounds low but if you end up in that 20 percent, the outcome is unlikely to be good. Rounding up to 25 — if there were four plates of food and one was poisoned and would lead to death, would you chance eating supper? So do we take the chance that he’ll be fine or try to prevent that 20 percent chance of a bad outcome?

He said we could have our local vet monitor Castiel every 1-2 months but he also said an X-ray wouldn’t detect the cancer cells early — it would  just detect spread to the lungs.  He said a CT would likely detect it, but you can’t just do CTs all the time. He said microscopic cancer cells were best treated when they are small but that we could use radiation later also, if needed. It might not be as successful though.

However, he also said radiation has significant side effects too, the worse being several years later. He said organs could be affected, as well as the spine and nervous system. It sounded really scary. On the flip side, our cat would be living long enough – years- to get potential side effects. And not every radiation patient gets these adverse effects, but he didn’t say these late effects were uncommon.

We discussed two types of radiation. The first involved Castiel going in for short low dose treatments five times a week for three weeks. This is the kind of radiation the oncologist before the surgery recommended. The second type involves 1-2 treatments of higher dose focused radiation; however, there is no good data on the efficacy, safety, and long-term effects of this kind of radiation. That is not to say it doesn’t work or that it isn’t safe; it only says the data hasn’t been peer reviewed and published yet. It hasn’t been scrutinized. Radiation treatment requires the cat be put under anesthesia each time – low dose anesthesia but fully out all the same, which has its own risks — although the doctor thought the risk of anesthesia problems was very low. Not zero but low.

If we did radiation, the lesser treatments sound like a good option and the doctor thought they would be best option for Castiel, although they need to do a second CT to understand where to focus the beam and probably other things I don’t know and failed to ask. He said which type he would ultimately recommend would depend on the CT.  Castiel hates to travel and travelling for radiation daily would be extremely difficult. He’d have to be boarded if we went to Campbell,  maybe not if we went to UC Davis. We hear Davis is very good too, but we worry about a teaching hospital. I know doctors have to learn but no one wants a serious illness treated by a first year intern if there is a experienced physician available. The second type of radiation would be easier on the humans and possibly on Castiel, but is it safe? All our decisions have been made on data and now we’re considering a treatment with no data. My husband is comfortable with that. He trusts doctors explicitly. I know that medicine is not an exact science. I question things more — I don’t know if that is better or worse, it’s certainly not easier.

We’re a mess tonight. Castiel is napping on his favorite chair with his belly in the air. He’s happy and ridiculous.

Our silly parlor panther

Oncologist Consult

We discussed the next steps with the oncologist today.  Unfortunately, no clear answers.  We have good margins.  But not good enough if it’s an injection site sarcoma.  Nothing in the pathology reports suggests an injection site sarcoma. But the location makes it a possibility.  And if it is, we’d need between 3 and 5 centimeters of margin.

If it were an injection site sarcoma, we’d definitely want to do radiation treatments.  Otherwise, we probably don’t want to put him through the stress of the treatments; but monitor him closely.   We got the doctor’s opinion, we just don’t know what to do.  We’re meeting with the radiation oncologist tomorrow for his opinion.

In the meantime – Cas looking adorable today.

Recovery Continues

Castiel is back to his usual hijinks…trying to steal his sibling’s food and currently begging for my husband’s steak. He’s Castiel just with three legs now. He’s finished all his medicine and seems to be doing well. We’ve been watching for signs of pain and we haven’t seen anything that raises our alarm, although we understand cats can hide pain. One of our biggest fears going into this was that he wouldn’t be like Castiel — that he might get depressed and shut down. Thankfully that has not been the case — and Castiel is nine so middle-aged, and he still seems to be adapting fine.

We’re expecting to have a consult with the oncologist tomorrow, so we will find out more then about whether radiation or radiation/chemo is recommended or whether we need to do anything but follow-up.  The consult was supposed to happen last week but the doctor didn’t call — other emergencies, I think.  I am expecting they will recommend radiation but we’ll wait and see. I think the fear is always that some some microscopic cells could have escaped. With good margins, I think it is unlikely but cancer can be sneaky. And the surgeon did mention to my husband that there was signs that the cancer was already trying to regrow where it is was removed from the first surgery (before the amputation).

On Wednesday, Castiel will get his sutures removed. It looks like it has been healing well. We’re dressing him in the onesie overnight so we can all sleep and so his one-year-old sister Clover doesn’t bathe his sutures or catch them if she decides to gets feisty.  But overall so far so good.

 

Steak! I love steak! Are we having steak?!
M’mm steak
Castiel relaxing on the sofa

 

Pathology Result Is In

Good News! The doctor called with the pathology results this evening and we have clear margins — cancer-free margins. The surgeon says he may not need to have to radiation therapy, although the oncologist may still recommend it to get any potentially microscopic cells that might have escaped, but so far so good. We will have a follow-up consult with the oncologist tomorrow. Anyway, we are all a little more relaxed this evening.

Castiel continues to recover well. I  was up all night writing a report for the boss last night but then crawled into bed for a a couple of hours in the early morning hours. Castiel curled right up into my arms and the two of us snoozed together. He is doing well with his balance and walking and remains steadfastly food motivated.  We are trying to watch his weight so it will be easier for  him to get around. Tonight he is up napping on his favorite blue chair. He is still taking the Buprenex and Gabapentin but we’ll see how he does as the week goes on. The swelling is going down slowly. I think we will all sleep a little better tonight now that we are past that scary bit.