7/27 Jessi, SCC tumor, time sensitive questions

[Suzanne & Darcy]

Your talk about sweet Jessi almost made me cry. Please keep us updated!! Lots of love and hugs and positive and hopeful thoughts are coming your way!

 

[Nimi S]

Hi Stefania,
Happy to see an update from you!
Wish I could help you in a better way but my experience and knowledge in this (SCC, CAT scan) area is zero and at best, limited. I try to read but I realise it wouldn’t make sense to offer inputs based on some cursory reading of the subject matter.
Feline diabetes itself is still a mystery after so many months of reading up on it.

A CAT scan requires full anaesthesia. Doing that twice in a short period to Jessi’s body doesn’t feel right to me. If it weren’t for that I probably would have agreed

I’m scared of anesthesia too, especially to have a cat undergo it twice within a short span.

If it were my cat, I wouldn’t agree to removing the lymph nodes unless it was known that there were tumors or cancerous cells in them. I would probably opt for diagnostics prior to undergoing any major surgery. But I know each cat and each caregiver and their circumstances are different.

I’m prejudiced towards this choice (getting a CAT scan) because I subjected a beloved cat to 2 major surgeries not knowing that no surgery was going to help him. A simple ultrasound could have helped us to know this and instead we could have spent his last few days spoiling and pampering him and saying good bye to him properly. In our case, the vets didn’t think it necessary to do an ultrasound covering more organs and I too didn’t know enough to ask. This experience has made me paranoid forever.

I know that Jessi’s prognosis is better and I shouldn’t project my experience.
I agree with what Eve says and it sounds good in theory - to do what seems necessary now and evaluate and address any issues/ complications later. I would personally want my cat to undergo one major surgery only, if it had some guarantee of success. Wishful thinking, I guess.

Such a tough, tough place for you to be in, Stefania. I wish there were better answers

I have asked the doctors in both clinics about the role the lymph nodes play and the possible effects of removing them, and they said the same thing, that the body would compensate by creating other channels for drainage and it wasn’t a big deal, something like that. When I mentioned their role in immune defense they basically denied or downplayed it. Today I confirmed that for myself with a quick online search. But it might also be true that if/when the immune system is not able to defend properly against cancer cells, it becomes a kind of catalyst or vehicle for it to spread. So they see the removal of the lymph nodes as taking away a potential pathway for spreading.

I know it’s not the greatest practice to just quote a part of one study out of hundreds but here is what I found with regards to removing lymph node as a part of cancer surgery (from a manual called BSAVA Manual of Canine and Feline Oncology Edited by J. Dobson and B. Lascelles - I have the PDF if you’d like to read it)

“The practice of routinely removing the ‘sentinel’ or regional lymph nodes in both humans and animals prophylactically is a matter of continued controversy but is generally no longer recommended (Krag, 2000).

In general, although decisions must be made on a case-by-case basis, current recommendations are the non-destructive biopsy (FNA) of grossly normal local nodes, and removal of the node in the following situations:

• The node is histologically proven to contain tumour cells
• The node appears grossly abnormal at surgery
• The node is intimately associated with the tissue being removed and surgical margins dictate its removal (e.g. as part of a compartmental resection such as the inguinal lymph node during mastectomy)
• The node is sufficiently large and/or located in such an area as to cause some degree of functional impairment associated with space occupation.”

There must be merits to both retaining and removing lymph nodes but such conclusions must ideally be drawn after vets perform the due clinical staging. I guess they could base their recommendations (to remove) on experience to which there isn’t much of an argument to make.

I know you’ve more or less made your decision but if find anything worth sharing on this topic, I will.

I switched clinics and I'm much happier with this one.

I’m really happy to read this update. I think it’s a great step in a positive direction that you’ve got a better team of vets - one that might be more pliable towards and respectful of your opinions.

I have no idea what is the right way. So ultimately I’ll have to choose what feels best.

Yep, given the limited knowledge anyone could have on this topic, a lot of the decision-making would rely on what one’s gut tells them to do.

Don’t beat yourself up over whatever it is that you decide to do. If there were only one option, there would be a clear answer. With multiple choices, it’ll always be a ‘What if I’d done this?’ situation.

I have no idea how this will go and the thought of that little delicate body and sensitive mind going through all of this is agonizing. I just take the next step, ask for support, set my intention for the best possible outcome, remember to breath, try to sleep enough and stay sane...and take another step....

I love this assertion. With the limited knowledge and information that you have on this topic and also the limitations on the treatments available to you, there really isn’t any way to be 100% sure about the decision that you make. You’ve very brave and I know how hard every single day of waiting is.

You think you're giving them something to make them better and it turns out it's feeding cancer cells!

If only there was a way to know everything about everything :’)
Shen got diabetes thanks to a steroid I had him put on for treating an allergy. I always regret it no matter what progress we’ve made today. I know I only wanted the best for him but my own limitations, wrt to being knowledgeable about so many things, are so disappointing to me.

Like Eve said, there’s a good chance that Jessi’s neuropathy will become better once her BGs become regulated. Let’s hold on to that hope. I love how you already have a set of positive affirmations ♥

I’m glad you have some sort of a system for the FD management in the interim.

Oh, you're so fun to vent with.
Thanks for all your support Nimi! You're such a good forum friend!

I’m glad to help in any way I can.

As for the venting, I sometimes have trouble keeping my mouth shut. I can go off about the vets to anyone who will listen.

As usual, I’ve left a huge wall of text. I worry that it sort of creates a clutter amongst the more informative texts

 

[Stefania S]

Could the X-ray be done right prior to surgery, straight after she's put under GA?
I had a similar conversation on another thread, where I found out in the US for example they don't sedate pets for scans/ultrasounds. Where I'm at, they do put pets under for these types of procedures, so they stay still. If that's the case in Italy too, I'd definitely request the X-ray immediately pre-op, killing two birds with one stone, if possible. It can 100% be done - while one of mine was under for a dental, they did a full body X-ray on my request, to confirm her arthritis.

Am I correct that Jessi's lump is on/around her neck and that's the area where you usually get the CGM placed too?
I understand how stressed she is (both mentally and physically) but you could always consider a different Libre placement? I pop it on mine's thorax, alternating sides. The one time the vet placed it, it was more on his shoulder/scapula in the hope it'd last longer on him... He peeled it off after 3 days When I apply it on his thorax at home it stays in-tact for at least 10 days and we only use SkinTac and a CGM patch on top, because he renders dead if there's any sort of clothing or bandage touches/"restricts" him. Dramatic much
Edit: I just wanted to add here, that I personally have some negative experience with the Libre constantly giving incredibly inaccurate readings in the higher numbers (as in +200 discrepancies!!!), but I understand it is not the case for everyone.

I also believe, once the tumor is off, her diabetes will be easier to control, which will lead her neuropathy easing tremendously.
Although we had gone through a whole different, non-tumor-related surgery a few days ago, my boy is stable now regarding his BG levels, and he isn't even fully recovered yet from the op! You too are fully aware of how much pain and discomfort affects BG levels. I have to admit I was a little sceptical on this matter, but seeing constant flat numbers for the past three days -for the very first time ever, since his diagnosis- was a real eye-opener for me.

By the way I wanted to say well done to colloidal silver. Not many know about its benefits.
Jessi is very lucky to have you going over and beyond for her

They will do an x ray before surgery and it doesn't require sedation at least it didn't in the previous clinic. They will probably do some bloodwork too.

The tumor is in the neck area where we had been putting the sensor. It was there for almost 3 years before starting insulin and using the sensor. But I am pretty sure the sensor along with the bandaging exacerbated the tumor which grew exponentially in just a few weeks.

I will absolutely find a new place for the sensor next time. When I took it off of her this last time I vowed never to put it on her neck again. I was thinking of putting it on her side, in the middle. She is ok with the t shirts I've been trying out on her, as long as they're soft and flexible, though they won't be enough if she decides the sensor has to go. Then again, it could be that once the tumor is gone and the wound healed, she will tolerate the sensor much better. If not I would have to put a wrapping around her middle, but unless people here in the forum tell me I should have it post-op, I would wait until she is fully recovered from surgery before putting one on.

Libre makes me very mad sometimes, but with me it has been ultra low numbers, the last one gave me 7 hours of 50 to below 40 range! At hour 7 it died. That's Libre fun for you! I had no way to confirm or negate the numbers because she is still too resistant to BG testing, but I'm pretty sure those were NOT accurate numbers.

It has its advantages but it is definitely flawed and pretty inadequate for getting precise moment to moment readings.

That's great and so encouraging to hear about your kitty stabilizing after his surgery. I sure hope that will happen for us too! I know the tumor is affecting Jessi so much. They say it isn't painful but, I don't know. I see her very low and just all around unhappy since it grew and since I started putting compresses on it and changing these regularly. It's as if it made her more aware of it and more uneasy.

Thanks for the praise! I sure can use it! So many doubts, so many moments of beating myself up for getting it wrong, for doing things that hurt or scare her, for knowing that my own weaknesses, bad habits, fears, and all the rest, affect her so much. Wish I could be the stable, calm, steady person she needs, in a stable, calm, steady environment...or at least, I wish she could run free outside like she used to be able to in the first years after I adopted her. She was in her element and she was healthy and strong. I feel that bringing her with me overseas to live in a small apartment in a city with two unpredictable humans was the beginning of her downward spiral. Not a day has gone by since then that I haven't felt deep sadness and pain knowing how healthy and free she was in that big open landscape (that's where she is in the photo). I have been trying to get us back to a place like that ever since, and I still wish that for us, especially for her at least in the remaining years of her life.

Right now maybe the hardest thing is how often I become the enemy to her with all that I have to do to her that scares her. Using force on these precious, sensitive beings is the worst for them. Some cats are used to letting people do stuff to them, but the essence of Cat is wild, that's what we love about them, even if we don't always like it. They're not supposed to be little teddy bears, sweet little princesses, or devoted companions, although they certainly can embody those traits for us sometimes (out of pure generosity, I think ). They are supposed to be fierce, wild, free and independent. If you don't like that about them you should get a dog! LOL! The way I see it, when we keep forcing our will on them again and again, it's like we're chipping away at that wildness, taming them, breaking their wills. Even if they do submit which not all do, something is lost that is so fundamental to who they are supposed to be.

But that's just my view, and I know every cat is unique. I see Jessi's will being broken with every moment of human intervention and it breaks my heart. I can feel what it does to her wild spirit.

I wonder how much of what I am doing to make her well is for me because I'm so attached and so scared to lose her. At the same time, I can't bear for her to suffer in any way. So if at some point the intervention becomes more a source of suffering than of relief and aid, I will have to make the hardest choice there is to make in this relationship.

Right now, I still feel a sense of new possibilities, of how we can come out of this stronger and better than ever and how she can regain the same vigor she had when she could run free among the wild things in the garden! Maybe she'll never be that Jessi again, but she could be a renewed Jessi, enjoying her life to the fullest for as long as she chooses to stay!

 

[Stefania S]

Hi Stefania,
Happy to see an update from you!
Wish I could help you in a better way but my experience and knowledge in this (SCC, CAT scan) area is zero and at best, limited. I try to read but I realise it wouldn’t make sense to offer inputs based on some cursory reading of the subject matter.
Feline diabetes itself is still a mystery after so many months of reading up on it.


I’m scared of anesthesia too, especially to have a cat undergo it twice within a short span.

If it were my cat, I wouldn’t agree to removing the lymph nodes unless it was known that there were tumors or cancerous cells in them. I would probably opt for diagnostics prior to undergoing any major surgery. But I know each cat and each caregiver and their circumstances are different.

I’m prejudiced towards this choice (getting a CAT scan) because I subjected a beloved cat to 2 major surgeries not knowing that no surgery was going to help him. A simple ultrasound could have helped us to know this and instead we could have spent his last few days spoiling and pampering him and saying good bye to him properly. In our case, the vets didn’t think it necessary to do an ultrasound covering more organs and I too didn’t know enough to ask. This experience has made me paranoid forever.

I know that Jessi’s prognosis is better and I shouldn’t project my experience.
I agree with what Eve says and it sounds good in theory - to do what seems necessary now and evaluate and address any issues/ complications later. I would personally want my cat to undergo one major surgery only, if it had some guarantee of success. Wishful thinking, I guess.

Such a tough, tough place for you to be in, Stefania. I wish there were better answers


I know it’s not the greatest practice to just quote a part of one study out of hundreds but here is what I found with regards to removing lymph node as a part of cancer surgery (from a manual called BSAVA Manual of Canine and Feline Oncology Edited by J. Dobson and B. Lascelles - I have the PDF if you’d like to read it)

“The practice of routinely removing the ‘sentinel’ or regional lymph nodes in both humans and animals prophylactically is a matter of continued controversy but is generally no longer recommended (Krag, 2000).

In general, although decisions must be made on a case-by-case basis, current recommendations are the non-destructive biopsy (FNA) of grossly normal local nodes, and removal of the node in the following situations:

• The node is histologically proven to contain tumour cells
• The node appears grossly abnormal at surgery
• The node is intimately associated with the tissue being removed and surgical margins dictate its removal (e.g. as part of a compartmental resection such as the inguinal lymph node during mastectomy)
• The node is sufficiently large and/or located in such an area as to cause some degree of functional impairment associated with space occupation.”

There must be merits to both retaining and removing lymph nodes but such conclusions must ideally be drawn after vets perform the due clinical staging. I guess they could base their recommendations (to remove) on experience to which there isn’t much of an argument to make.

I know you’ve more or less made your decision but if find anything worth sharing on this topic, I will.


I’m really happy to read this update. I think it’s a great step in a positive direction that you’ve got a better team of vets - one that might be more pliable towards and respectful of your opinions.


Yep, given the limited knowledge anyone could have on this topic, a lot of the decision-making would rely on what one’s gut tells them to do.

Don’t beat yourself up over whatever it is that you decide to do. If there were only one option, there would be a clear answer. With multiple choices, it’ll always be a ‘What if I’d done this?’ situation.


I love this assertion. With the limited knowledge and information that you have on this topic and also the limitations on the treatments available to you, there really isn’t any way to be 100% sure about the decision that you make. You’ve very brave and I know how hard every single day of waiting is.


If only there was a way to know everything about everything :’)
Shen got diabetes thanks to a steroid I had him put on for treating an allergy. I always regret it no matter what progress we’ve made today. I know I only wanted the best for him but my own limitations, wrt to being knowledgeable about so many things, are so disappointing to me.

Like Eve said, there’s a good chance that Jessi’s neuropathy will become better once her BGs become regulated. Let’s hold on to that hope. I love how you already have a set of positive affirmations ♥

I’m glad you have some sort of a system for the FD management in the interim.


I’m glad to help in any way I can.

As for the venting, I sometimes have trouble keeping my mouth shut. I can go off about the vets to anyone who will listen.

As usual, I’ve left a huge wall of text. I worry that it sort of creates a clutter amongst the more informative texts

NIMI NIMI NIMI!!! Never apologize! your words are so welcome here! And besides, you have a sixth sense when it comes to knowing when and how much to post. If something you share isn't useful or right for me, that's for me to know and choose accordingly, which is how it always is with everything really, right?

What you just posted was exactly the piece I needed to confirm what I already was feeling but needed to back up with something rational. I know it is just one excerpt from one journal, but that was all I needed.

From the moment the first Vet mentioned removing lymph nodes I felt uneasy. It just felt counterintuitive. Isn't that one of the immune system's first lines of defense against bacteria, viruses, and, oh wait, um cancer cells? But I listened to the rationale and I bought it for a little while. 'The lymph nodes can be a doorway to cancer cells spreading so we usually remove the ones closest by as a safety precaution,' they said, and I believed them and felt worried. I should do what they say because they know about these things and I don't.

But that piece that you shared was all I needed to help me get past the hyper rational mind's objections. I don't know why I haven't put the time into researching these things myself. I usually do. Somehow, lately, I seem to not be doing much of that. Maybe I'm just a bit too overwhelmed with things to do. Or maybe it was feeling better to look to others here for support rather than doing it all on my own as I have for so long.

You did the research for me! And others have shared their knowledge and experience at just the moment when I needed it!

The lymph nodes stay! Yes, they could argue that a CAT scan could show that they need to be removed, it's true, but, I just can't put her through that right now. She has had x ray and ultrasound already. I may let them do another x ray the day of surgery, still thinking about that....

And as Eve (is it?) said, I can always opt for more tests once she is all better from surgery, if we choose.

I so hear you about beating yourself up and thank you for the empathy on that one! It really is impossible to get it all right and so often a solution to one problem creates several or sometimes just one big other problem! How can we not feel responsible when we were the ones who made that choice. But we know that we did it with the best intentions and we just didn't know what would happen.

We are learning and evolving as we go and it can be a bumpy process. Our precious animal friends are coming along that ride with us for better or for worse, right?

But look at you! You got Shen OTJ in such a short time! Wow! I am sure you feel so good about that! I get chills just thinking about it!

 

[Stefania S]

Hard, cold facts recap and update:

We have a surgery date set for Wednesday Aug 2 first thing in the morning. They want to do an X ray and blood work. I may pass on the X ray, since we had one a few weeks ago, still deciding on that. They want to do it in case anything has changed, as in the spreading of unwelcome cells. It shouldn't require anesthesia but I am asking them about that soon.

I told them no CAT (funny that it's called that, huh? ) I will tell them also no lymph nodes. Now I have to decide on the margin, just how much or if any. I found out talking to the surgeon on the phone that anything less than 3cm is considered palliative. Wow! What I don't understand yet, and will ask, but if you know this please share, is what does it mean to say a '3cm margin' is that a diameter or a radius outward from the center (the mass itself). Meaning is that a total of 3 cm or being a margin it could actually mean more like a 6 cm diameter, if you take the tumor as the middle of that circle. Big difference, so I have to find out.

At this point, I'm moving more and more in the direction of less is more. The surgeon says she will take as much margin as she can without requiring a flap (if you don't know what that is, it's better that way, awful stuff!) but I don't know how much exactly that means. If I leave it up to her she will decide in the moment how much that is, so I better get really clear on how much of a 'margin' she should be taking.

After surgery they test the perimeter of the incision and they do a histological of the site to find if it is 'clean' or 'dirty' or this other category 'clean but close' (they actually use the English term).

They will also remove another ugly spot on her skin near the tumor which bothers her a bit and that is a small, simple incision.

I will ask them to go as light as possible on anesthesia, without leaving her awake of course, especially considering how sensitive Jessi is and all her physical challenges.

I'll ask them to get my explicit permission before administering any pharmaceuticals whatsoever including antibiotics, pain killers, anti-inflammatory meds, so if you have any input on this, let me have it please! Same goes for anesthesia and anything else related to this process.

I posted a new thread about BG, insulin and anesthesia interaction. You can find it here:

https://www.felinediabetes.com/FDMB...thesia-reduce-hold-other.280032/#post-3091655

That's it for now.

I couldn't be staying sane right now if it wasn't for you all!!!

 

[Stefania S]

Your talk about sweet Jessi almost made me cry. Please keep us updated!! Lots of love and hugs and positive and hopeful thoughts are coming your way!

 

[Stefania S]

should I be starting a new thread? I know this one got quite long. I apologize. I'm worried if I do that we'll lose the conversation and kind of have to start over. I have only a couple of more days to make some major decisions. Is it ok to leave it here a couple of more days?

 

[Stefania S]

Darn, I'm feeling nervous and having second thoughts about everything now! Maybe I should have done the CAT scan...maybe I should have them remove the lymph nodes...

She looks so low all the time these days. And I can't see her BGs which is making me increasingly anxious. Is she super high, super low, is she feeling off from the tumor, from stress, from other things? Has the cancer spread...should I be more aggressive about all this? Am I being too afraid of stressing her and avoiding doing things that should be done?

So many doubts setting in now right before I send an email off to the Oncologist and surgeon with questions and my statement about not removing the lymph nodes.

Nimi, I noticed that article you quoted is 23 years old. Is there a more current one that has a similar statement? When I look online I can't find anything about it being controversial to remove them in a case like this or info with negative effects of removing lymph nodes. I just don't have a lot of time or attention span to do research right now, and the pressure is intensifying as the surgery date approaches.

I'll probably feel different again later...but right now, I'm so unsure.

I just found out that anesthesia can lower BGs from my recent post about this.

https://www.felinediabetes.com/FDMB...thesia-reduce-hold-other.280032/#post-3091675

This means I really need to have her monitored post-op, so either I let them keep her overnight, or I have them put a sensor on, which they probably have no experience doing, or both, I have them keep her and put a sensor on. Endless questions and problems to solve....

 

[Nimi S]

I found out talking to the surgeon on the phone that anything less than 3cm is considered palliative. Wow! What I don't understand yet, and will ask, but if you know this please share, is what does it mean to say a '3cm margin' is that a diameter or a radius outward from the center (the mass itself). Meaning is that a total of 3 cm or being a margin it could actually mean more like a 6 cm diameter, if you take the tumor as the middle of that circle. Big difference, so I have to find out.

From what I could understand, a surgical margin is not measured from the centre of the tumor but from the outer edge of the tumor. So let’s say, the tumor itself (assuming it’s roughly the shape of a circle) has a radius of 3cm, then a margin of 2cm would mean drawing an outer circle around the tumor with a radius of 5cm( the centre of the marginal circle being the centre of the tumor) . But if the tumor has a different shape, then the margin would be similarly shaped at equidistances.
Although I think if there’s enough of a pre-surgery inspection done to check the spread of the tumor, the margin can differ around the tumor to save as much of the healthy parts of the body as possible.
An image of how the margin is measured wrt the edge of the tumor

(source: https://shorturl.at/psAFP)

another image

This website says, ‘In pathology, a margin is the edge of a tissue that is cut when removing a tumour from the body. The margins described in a pathology report are very important because they tell you if the entire tumour was removed or if some of the tumour was left behind. The margin status will determine what (if any) additional treatment you may require.’

After surgery they test the perimeter of the incision and they do a histological of the site to find if it is 'clean' or 'dirty' or this other category 'clean but close' (they actually use the English term).

Another image explaining what you’re describing, but using slightly different terminology for the margins.

Source: https://rb.gy/vxisl

ETA:

Nimi, I noticed that article you quoted is 23 years old. Is there a more current one that has a similar statement?

Lemme get back to you on this!

 

[Nimi S]

Nimi, I noticed that article you quoted is 23 years old. Is there a more current one that has a similar statement? When I look online I can't find anything about it being controversial to remove them in a case like this or info with negative effects of removing lymph nodes

I just want to preface by saying that most of the studies discuss prophylactic removal of cytologically negative lymph nodes i.e. lymph nodes which have been tested in some way to ascertain whether they are metastatic or not and were found to be negative.

If I recall and understand correctly, the vets weren’t able to perform a biopsy of Jessi’s lymph nodes, so it isn’t clear whether they’re cytologically positive or negative. Please correct me if I’m wrong!
I don’t think there would have been any argument or discussion had the lymph nodes turned out to be positive during the staging process.
Without a result, would you assume that the lymph nodes are cytologically positive or negative? That would/ should determine which side you’d want to lean on while deciding on the removal.
I do feel a CAT scan done properly might help reveal the need to remove or retain the lymph nodes. I totally understand your hesitation though

I’ll link articles that discuss both the pros and cons.

Here’s a link (from a book Surgical Oncology - first print 2021) that gives the pros and cons of resection of affected lymph nodes

Source: https://rb.gy/4ahb3 (scroll down to page 12 if link opens on the cover page..Sorry, I couldn’t copy the text!)

Another slightly dated (2007) excerpt from WITHROW AND MACEWEN’S SMALL ANIMAL CLINICAL ONCOLOGY - it mentions the general circumstances in which lymph nodes should and should not be removed.

Source: https://shorturl.at/suHX8 (scroll to page 152 if link opens on the cover page)

I’ll keep adding to this while you peruse these 2 links. Will you let me know if the 2 images aren’t clear enough to see?

I was a bit surprised to see that the more recent articles in support of lymph node removal are studies conducted by vets from the University of Bologna. Maybe it’s a coincidence. I’ll link them here in a bit.

here’s a study on the therapeutic role of lymphadenectomy of uninvolved regional LNs (studied on dogs with mast cell tumors). It concludes that ‘lack of immediate lymphadenectomy was associated with a higher risk for tumor progression. This preliminary judgement, reinforced by the findings that lymphadenectomy was well tolerated in all cases, and that histopathology provides the definitive assessment of the nodal pathological status, may suggest that prophylactic lymphadenectomy is indicated in the management of stage I MCTs. Larger prospective studies are warranted for generating clinical evidence of this latter hypothesis’

This is another recent study - Complications following lymphadenectomy: a prospective study in canine patients. It says ‘In conclusion, lymphadenectomy of the superficial LNs is associated with a high rate (58%) of self-limiting mild complications, that usually resolve in few days without treatment, and a low rate of moderate (3%) and severe (1.5%) ones.

A prolonged surgical time may affect the complication rate, but the increase of the use of more sophisticated techniques of LN detection may reduce it in a near future. The en bloc excision of mandibular and retropharyngeal LNs, mandibular alone LNs and the use of MBD seems to be associated with a higher rate of complications.

Therefore, given the limited number of predictive factors identified in this study, other possible risk factors should be explored in future studies with larger numbers of cases to identify whether there is a statistically significant correlation between complications and some variables. Further prospective studies are needed to validate the results before attempts can be made to develop a clinical prediction rule.

Overall, lymphadenectomy can be considered a safe and easy procedure for qualified surgeons, worth being performed for diagnostic purposes, although a standardized approach to lymphadenectomy of different sites would be needed.’

A few more links ( I can share pdfs since google books has limited preview) in favour of removing lymph nodes.

From Veterinary Oncology - A Short Textbook (2016)

From Veterinary Surgical Oncology (2022)

Also I’m sorry I didn’t check how old the article I’d linked earlier was

 

[Stefania S]

I just want to preface by saying that most of the studies discuss prophylactic removal of cytologically negative lymph nodes i.e. lymph nodes which have been tested in some way to ascertain whether they are metastatic or not and were found to be negative.

If I recall and understand correctly, the vets weren’t able to perform a biopsy of Jessi’s lymph nodes, so it isn’t clear whether they’re cytologically positive or negative. Please correct me if I’m wrong!
I don’t think there would have been any argument or discussion had the lymph nodes turned out to be positive during the staging process.
Without a result, would you assume that the lymph nodes are cytologically positive or negative? That would/ should determine which side you’d want to lean on while deciding on the removal.
I do feel a CAT scan done properly might help reveal the need to remove or retain the lymph nodes. I totally understand your hesitation though

I’ll link articles that discuss both the pros and cons.

Here’s a link (from a book Surgical Oncology - first print 2021) that says that gives the pros and cons of resection of affected lymph nodes

View attachment 67347



Source: https://rb.gy/4ahb3 (scroll down to page 12 if link opens on the cover page..Sorry, I couldn’t copy the text!)

Another slightly dated (2007) excerpt from WITHROW AND MACEWEN’S SMALL ANIMAL CLINICAL ONCOLOGY - it mentions the general circumstances in which lymph nodes should and should not be removed.

View attachment 67348

Source: https://shorturl.at/suHX8 (scroll to page 152 if link opens on the cover page)

I’ll keep adding to this while you peruse these 2 links. Will you let me know if the 2 images aren’t clear enough to see?

I was a bit surprised to see that the more recent articles in support of lymph node removal are studies conducted by vets from the University of Bologna. Maybe it’s a coincidence. I’ll link them here in a bit.

Also I’m sorry I didn’t check how old the article I’d linked earlier was

OMG you have got to be kidding me! increased morbidity! OK, that's enough for me! Who cares what year they're from, right?

And OMG I can't believe the only stuff you found in favor was from U Bologna!!! WTF! Scuse my language! I need to get us out of this plaaaace!!! I am this close to canceling the surgery. How do I trust these people? How do I put her in their hands???

 

[Nimi S]

And OMG I can't believe the only stuff you found in favor was from U Bologna!!! WTF

Sorry, I should have worded it better! I was specifically looking for a case like Jessi’s where LNs were suggested to be removed even if they were not metastatic or were uninvolved. For those specific cases, the most recent studies are by the Uni of Bologna.

If you see my edits to my previous post, I’ve added a few more links which suggest removing LNs as a good thing but the qualifier in most cases is that the LNs are diagnosed to be metastatic or there was evidence of LNs becoming metastatic for certain types of cancer.

I am this close to canceling the surgery. How do I trust these people? How do I put her in their hands???

I’m sorry if I’ve added more doubt than you were already feeling today While reading all this stuff, I realised that there’s a lot of info on the internet but it’s not possible to know for sure that our understanding of it is correct as opposed to that of the vets. I’ve had a bad experience with vets on the topic of FD and another surgery (PU) too, so I’ve become very distrustful of their suggestions. But at the end of the day, for major interventions like surgeries, the vet is who I’ll have go to.
My point being, while I’m sharing relevant stuff with you, it could very well be a case of A little knowledge is a dangerous thing. And that we’ve to hope that the vets know what they’re talking about to some extent, at least.

Just use this info so that you’re more or less aware of what their suggestions or decisions may mean, since they may not bother expanding on those things. It’s a really huge topic, just like FD, and it isn’t possible to understand the implication of all those things overnight

I’ve overloaded you with a lot of info but I’m still sharing this last bit.

I found out talking to the surgeon on the phone that anything less than 3cm is considered palliative.

I’m curious what they consider to be palliative. Most animal oncology books I skimmed through had this to say about palliative surgery:
Palliative Surgery
• A surgery performed to improve quality of life when progression of the cancer is expected despite surgical intervention
• Examples of this include
Limb amputation for osteosarcoma causing lameness
Removal of large ulcerated painful mammary carcinomas
Placement of a permanent cystostomy catheter to relieve urine outfl ow obstruction in dogs with transitional cell carcinoma

Do the vets think that Jessi’s SCC will progress despite the surgery? I thought the prognosis was optimistic.

A bit old (2013) but this article has a section on determining surgical margins which makes me wonder about the ‘less than 3cm being palliative’ remark. Things could very well have changed in the last 10 years though, so take it with a pinch of salt.

ETA: Not saying that margins less than 3cm can’t be considered palliative in certain cases, but was unsure if Jessi’s case also qualifies as palliative (I shouldn’t comment since I don’t even know the size of the tumor/ulcer)

Another book that I found really informative and simple to understand. If/when you have the time and mental bandwidth, please skim through pages 69-77 (page nos. as printed on the bottom) regarding cancer treatment modalities. I’d have copied what I found helpful there, but I’m afraid the already long posts will make it difficult for other members to contribute here I do wish someone else could chime in too, but maybe it’s a complex topic.


It’s a lot of info and I hope the vets there are kind enough to explain their suggestions to you properly. If not, go with what seems like the best choice to you. It’s really not a subject we should be experts in, so don’t kick yourself about it (too much).

Hugs to you and Jessi!

 

[.:. in.active .:.]

I cannot comment on the nature of the actual surgery, however, what I can tell you is that I have received different advices by my private vet and the organisation who did do my cat's surgery a week ago regarding insulin dosage pre-anaestesia.
Essentially, however, the AAHA link that was shared with me by my private vet coincidentally resonated with the advice of the actual surgeon, which was
- feed the cat a tiny amount of food at 5am
- shoot half a dose of his normal insulin
I had to drop him off at 08:30am and they operated on him at 11:30am just past nadir, when he was already curving up slightly. Nonetheless, I saw his records, and his BG was stable all throughout the day. Due to his heart murmur, they wanted to be over and done with the procedure as soon as possible, but he still needed extended length anaesthesia (over an hour). He is an extremely sensitive cat, yet his vitals were stable throughout the procedure, I even received a call while he was still under and they working on him, as welk as straight after. I prompted the vet to put a new Libre on him at the end of the surgery, but she was unable to do it, because he woke up incredibly fast, surprising everyone around - which is a good thing, given the fact we weren't even sure whether he'd wake up at all.

It may not be not much reassurance at the moment, but I wanted to share our positive experience and how vets here deal with diabetic patients that undergo surgery and the anaesthesia vs insulin protocol.

For post-op pain relief I specifically requested Buprenorphine, as Gabapentin and Codein tempers with BG (runs my boy's horrendously high). As NSAID we received Meloxicam, which I'm aware of being a controversial drug in the US but all my cats have used it without any issues. In fact, I found it more beneficial than the opioids mentioned above, although it may be to do with his dealing with more pain related to inflammation as opposed to other factors.

Edit: Anaesthesia did not lower my cat's BG at all throughout the procedure/that AM. Him not eating much post-op and me shooting his regular dose at PM was the culprit of him dropping low, only once that day (well... night, really). But it was a one off, and a mistake of mine, which you can easily learn from, so you won't repeat it with Jessi

 

[Stefania S]

Sorry, I should have worded it better! I was specifically looking for a case like Jessi’s where LNs were suggested to be removed even if they were not metastatic or were uninvolved. For those specific cases, the most recent studies are by the Uni of Bologna.

If you see my edits to my previous post, I’ve added a few more links which suggest removing LNs as a good thing but the qualifier in most cases is that the LNs are diagnosed to be metastatic or there was evidence of LNs becoming metastatic for certain types of cancer.


I’m sorry if I’ve added more doubt than you were already feeling today While reading all this stuff, I realised that there’s a lot of info on the internet but it’s not possible to know for sure that our understanding of it is correct as opposed to that of the vets. I’ve had a bad experience with vets on the topic of FD and another surgery (PU) too, so I’ve become very distrustful of their suggestions. But at the end of the day, for major interventions like surgeries, the vet is who I’ll have go to.
My point being, while I’m sharing relevant stuff with you, it could very well be a case of A little knowledge is a dangerous thing. And that we’ve to hope that the vets know what they’re talking about to some extent, at least.

Just use this info so that you’re more or less aware of what their suggestions or decisions may mean, since they may not bother expanding on those things. It’s a really huge topic, just like FD, and it isn’t possible to understand the implication of all those things overnight

I’ve overloaded you with a lot of info but I’m still sharing this last bit.

I’m curious what they consider to be palliative. Most animal oncology books I skimmed through had this to say about palliative surgery:
Palliative Surgery
• A surgery performed to improve quality of life when progression of the cancer is expected despite surgical intervention
• Examples of this include
Limb amputation for osteosarcoma causing lameness
Removal of large ulcerated painful mammary carcinomas
Placement of a permanent cystostomy catheter to relieve urine outfl ow obstruction in dogs with transitional cell carcinoma

Do the vets think that Jessi’s SCC will progress despite the surgery? I thought the prognosis was optimistic.

A bit old (2013) but this article has a section on determining surgical margins which makes me wonder about the ‘less than 3cm being palliative’ remark. Things could very well have changed in the last 10 years though, so take it with a pinch of salt.
View attachment 67360

ETA: Not saying that margins less than 3cm can’t be considered palliative in certain cases, but was unsure if Jessi’s case also qualifies as palliative (I shouldn’t comment since I don’t even know the size of the tumor/ulcer)

Another book that I found really informative and simple to understand. If/when you have the time and mental bandwidth, please skim through pages 69-77 (page nos. as printed on the bottom) regarding cancer treatment modalities. I’d have copied what I found helpful there, but I’m afraid the already long posts will make it difficult for other members to contribute here I do wish someone else could chime in too, but maybe it’s a complex topic.


It’s a lot of info and I hope the vets there are kind enough to explain their suggestions to you properly. If not, go with what seems like the best choice to you. It’s really not a subject we should be experts in, so don’t kick yourself about it (too much).

Hugs to you and Jessi!

Ok, thanks for all the info Nimi. I am going to stick with my decision. I could go back and forth forever and never know which is the right one, so at this point I have to follow my gut.

In either case, there are no guarantees. It's all about weighing the risks and benefits, the pros and cons...and then that feeling that I try to follow.

Please don't take this on as your responsibility. Know that whatever my choice and whatever the outcome, it is my responsibility and no one else's. I gather opinions, info, perspectives, etc...then I check in with myself and see what seems right to me. My rational mind can kick in anytime and make me doubt everything, fear the worst, go crazy with anxious thoughts, (and make the Vets a bit crazy too, Lol!) but then I come back to that core knowing and I have to follow it. Does that mean everything will go just like I want it to? It might, it might not. That's how it is.

At this point, the best to do is send lots and lots of positive thoughts, wishes, prayers, visualization, whatever works for you for the best outcome to this process, Jessi coming out of this relieved of something that was weighing on her, free to get so much healthier and be so much more vibrant, playful, feisty, fully feline!

 

[Stefania S]

I cannot comment on the nature of the actual surgery, however, what I can tell you is that I have received different advices by my private vet and the organisation who did do my cat's surgery a week ago regarding insulin dosage pre-anaestesia.
Essentially, however, the AAHA link that was shared with me by my private vet coincidentally resonated with the advice of the actual surgeon, which was
- feed the cat a tiny amount of food at 5am
- shoot half a dose of his normal insulin
I had to drop him off at 08:30am and they operated on him at 11:30am just past nadir, when he was already curving up slightly. Nonetheless, I saw his records, and his BG was stable all throughout the day. Due to his heart murmur, they wanted to be over and done with the procedure as soon as possible, but he still needed extended length anaesthesia (over an hour). He is an extremely sensitive cat, yet his vitals were stable throughout the procedure, I even received a call while he was still under and they working on him, as welk as straight after. I prompted the vet to put a new Libre on him at the end of the surgery, but she was unable to do it, because he woke up incredibly fast, surprising everyone around - which is a good thing, given the fact we weren't even sure whether he'd wake up at all.

It may not be not much reassurance at the moment, but I wanted to share our positive experience and how vets here deal with diabetic patients that undergo surgery and the anaesthesia vs insulin protocol.

For post-op pain relief I specifically requested Buprenorphine, as Gabapentin and Codein tempers with BG (runs my boy's horrendously high). As NSAID we received Meloxicam, which I'm aware of being a controversial drug in the US but all my cats have used it without any issues. In fact, I found it more beneficial than the opioids mentioned above, although it may be to do with his dealing with more pain related to inflammation as opposed to other factors.

Edit: Anaesthesia did not lower my cat's BG at all throughout the procedure/that AM. Him not eating much post-op and me shooting his regular dose at PM was the culprit of him dropping low, only once that day (well... night, really). But it was a one off, and a mistake of mine, which you can easily learn from, so you won't repeat it with Jessi

Thanks for the share and suggestions! I hope she won't need much in the way of post-op meds since it is mostly on the surface, but I'll have to talk to the vets about it. That's good to hear that your cat didn't drop during surgery, but maybe he dropped after surgery in response to the anesthesia and meds...

She has to be fasting for blood tests and x ray before surgery at 8:30. As far as I know any food in the digestive system is not such a good thing during anesthesia. I'm surprised they were ok with your kitty eating in the morning. But I guess they figured 6.5 hours were enough time for the food to be out of his system.

I won't give AM insulin and I'll wait to see how she is doing and if she can eat normally before giving PM insulin, which I can always stall if I need to. If we have to skip two doses so be it. If I don't manage to get a sensor put on before she comes home, all the more reason to be super cautious. I think I'll start a new thread for this at this point because we're getting into dosing advice.

 

[Stefania S]

I just got rejected by the Vets at the new clinic. They told me they can't work with me because I don't trust them. I don't know what to do. I can't believe this is happening. I have nowhere to go.

 

[.:. in.active .:.]

Holy sh*t are you kidding me?

Just to clarify, it's not the clinic that scheduled Jessi's surgery for tomorrow, right?

(His BG didn't drop post-op due to anaesthesia or the meds - he's been on the meds listed pre-op too, and we had no BG issues. It has 100% dropped due to lack of food, as he only had 20g of MC wet at 5am and practically nothing until 8am the following morning, thus he was nil by mouth for over 24hrs - he was not hungry and/or in too much discomfort to eat anything but yoghurt, which let's face it, even that being HC didn't do too much at that point haha!
Feeding pre-op was only required due to insulin administration, and they're only reluctant of it in case of regurgitation while under and have a tune down their throat. Given how little he hate that morning, there were no issues.
Hope this puts your mind at ease at least a little bit.)

 

[Stefania S]

Holy sh*t are you kidding me?

Just to clarify, it's not the clinic that scheduled Jessi's surgery for tomorrow, right?

(His BG didn't drop post-op due to anaesthesia or the meds - he's been on the meds listed pre-op too, and we had no BG issues. It 100% drop due to lack of food, as he only had 20g of MC wet at 5am and practically nothing until 8am the following morning, thus he was nil by mouth for over 24hrs.
Feeding pre-op was only required due to insulin administration, and they only reluctant of it in case of regurgitation while under. Give how little he hate, there were no issues.
Hope it puts your mind at ease at least a little bit.)

Yes, they canceled the surgery for tomorrow because of the email I sent with requests and specifications which I thought I could make but obviously couldn’t. I am having a panic attack and hitting rock bottom right now all by myself.

 

[.:. in.active .:.]

OH MY GOD STEF!
Is there anything I can do? Feel free to drop me a DM, we are on a similar time zone so I'm available to chat "real time" if you needed someone to get you through the panic attack. I'm way too familiar with those, so please do reach out if you need to!

 

[Nimi S]

I just got rejected by the Vets at the new clinic. They told me they can't work with me because I don't trust them. I don't know what to do. I can't believe this is happening. I have nowhere to go.

WTF is wrong with them? I can’t wrap my head around this. I had no idea asking for more information and making requests would lead to this.

I don’t even want to suggest this but do you think requesting them to reconsider their decision after a couple of days would help to try?
I know your options were already limited and the first one sucked to begin with, but are they still open to working with Jessi?
This is such a shitty situation. Please let me know if I can help in any way at all.

 

[Stefania S]

Yeah, it all around sucks, you got that right. I already spoke to the wonderful vet I love so much at the University clinic. She used my vulnerable position to give me a little slap on the wrist and patronize me about needing to put aside my worry about Jessi’s stress level and do what needs to be done. She said if I had just gone to the appointment last week they would have given me a surgery date probably for tomorrow, making it my fault this was happening, making me explain myself and grovel. She emphasized lymph node removal again. She told me I would need to care for her wounds after surgery so I should really think about it. Freakin amazing. Nice little lecture. So enfuriatingly patronizing and lacking all understanding of my relationship with my cat and how much I do for her.

Omg I’m so tired. I can’t even muster the strength to be angry. Be angry for me y’all

 

[Stefania S]

WTF is wrong with them? I can’t wrap my head around this. I had no idea asking for more information and making requests would lead to this.

I don’t even want to suggest this but do you think requesting them to reconsider their decision after a couple of days would help to try?
I know your options were already limited and the first one sucked to begin with, but are they still open to working with Jessi?
This is such a shitty situation. Please let me know if I can help in any way at all.

Nimi, they were too abusive. They stayed on the phone with me for more than a half hour just repeating again and again that my mode and my lack of trust were the problem. No matter what I said they repeated this and that they couldn’t do the surgery, I should go somewhere else. Why did they spend all that time just to tell me that?

When I practically pleaded with them to think of Jessi and how urgent it was and how I would have to take more time now finding another place, one said, ‘Well, it’s been there for 3 years s few more days won’t make a difference. It’s probably already spread to other areas anyway by now.’

I can’t go back.

 

[.:. in.active .:.]

they repeated this and that they couldn’t do the surgery, I should go somewhere else
[...]
‘Well, it’s been there for 3 years s few more days won’t make a difference. It’s probably already spread to other areas anyway by now.’

There it is! My gut, goddamn...
The first thought that popped in my mind after seeing that they've withdrawn from the surgery was that they'd likely realised it was a bigger bite than what they could chew. The fact that they rather gaslight you and make up excuses than to admit that they're likely incompetent to successfully execute the surgery is appalling!
(My cat's pre-op notes from the surgeon was written in a similar tone, with a wording "the owner isn't sure about the operation" when in fact the surgeon was the one coercing me to cancel it due to my cat being high risk, and her being scared of the consequences of/if her screwing up the procedure. I went ballistic on them!)

I'm so so angry for you Stef!
Is there any other practice in the surrounding areas outside of Bologna that would be able to take Jessi, urgently? Do you have friends or family in other cities with better veterinary practices perhaps, that you could attend and whom you'd be able to stay with temporarily?

My brain is in override, I haven't been to Italy in 3 years but trying to recall connections I have in Rome and Venice (although I guess the latter is out of question). I'll let you know if I came up with something and/or could reach anyone that could be of help, pronto.

 

[Nimi S]

Nimi, they were too abusive. They stayed on the phone with me for more than a half hour just repeating again and again that my mode and my lack of trust were the problem. No matter what I said they repeated this and that they couldn’t do the surgery, I should go somewhere else. Why did they spend all that time just to tell me that?

When I practically pleaded with them to think of Jessi and how urgent it was and how I would have to take more time now finding another place, one said, ‘Well, it’s been there for 3 years s few more days won’t make a difference. It’s probably already spread to other areas anyway by now.’

I can’t go back.

What in the world?? I can’t imagine that anyone who speaks in such a way could possibly love an animal. So, so callous and heartless.
And what a way to flip the attitude they showed earlier.

‘It’s probably already spread to other areas anyway by now.’

So a month ago the assessment was that it hasn’t spread to the other organs but now there’s a probability that it has? I know things can change anytime but this was totally said with no other intention than to cause you hurt and worry during a time when you’re already so down. What a bunch of sadists.

I’m sorry I suggested that you try to ask them to reconsider, without thinking that you would have done anything in your power to do so already.

And it sucks that the vets at the university are using this to push you into a corner. Why are they all on a power trip?


I wish you and I lived in the same side of the world so that I could help you better with finding out a good vet for Jessi.
Since it’s been more than a month since the SCC diagnosis, I assume you would now stick with the university vets for the surgery? I hope the university doesn’t add more delays since you’d said things move slowly there.

I’m constantly hoping and praying for the best for you and Jessi. I hope you can get over this soon. I know it’s a very difficult and painful day for you, but today’s the time to think of positive outcomes only for you and Jessi. This too shall pass.

 

[JL and Chip]

I’ve been following along loosely, though the sheer number and length of posts are a lot to take in.

I’m on Jessi’s side, so please take the following comments in the positive and caring vein in which they’re intended.

First, please always try to remember that “it’s all about the cat.”

What I mean by that is that it’s very easy, especially when stressed, emotional, anxious, whatever, to take things personally or become indignant, but that doesn’t help the cat. This is not a criticism; we all do it, it’s human nature. But try to squash those feelings down and focus on what it will take to achieve the goal — getting Jessi surgery and treatment.

Second, understand that vets are human too. Is it possible that the vets are being arrogant jerks? Yes (and I’ve dealt with a few over the years). But, it’s also possible that they truly care about doing right by Jessi but that they perceived some red flags (valid or not) in their communications with you that made them uncomfortable — so they opted to cancel surgery either because they didn’t feel the situation would allow them to do what’s best for Jessi or to avoid potential drama.

There’s a fine line between advocating for your cat vs micromanaging so much that the vet questions whether they can do their job — i.e., do what’s best for the cat. It’s one thing to answer yes/no if they ask permission to do a CT scan or remove a lymph node as a precaution. A lot of times they don’t know what they’re going to find until they get in there. It’s another thing entirely, for example (and I’m not saying you did this) to dictate what anesthesia or pain meds can be used, what margins should be taken, how/where to place the incision, how long the cat should be hospitalized, what antibiotics or fluids should be given, etc. Those decisions are the very thing we depend on them and their training/expertise to know how to do. Again, I’m absolutely NOT saying you did any of those things. I’ve just been on both sides of the clinic wall and seen some very good vets get exasperated by good-intentioned individuals who didn’t really understand the consequences of what they were demanding. (I’ve also absolutely have crossed paths with vets who are offended/insulted when one dares to ask questions, so yeah, that happens too ).

I’ve sat in far too many exam rooms over the years and I tend to ask a lot of detailed questions, so I’m sure I’ve tried the patience of a few vets (lol). Here are a few suggestions I’ve learned along the way...

• Ask the vet what decisions they need you, as the cat’s owner, to make. Many will be financially driven, some might be medical. For example, should we do a CT scan?

• For each decision you have to make, ask the pros/cons.

• Ask for their recommendations and the logic behind them.

• If surgery is involved, is it likely to be curative?

• What are the likely lifespans with and without surgery/treatment?

• What is the typical trajectory of the disease?

• Identify your concerns (fears?) and ask the vet to validate whether they’re real risks or perhaps just perceived (fear of the worst/unknown can skew our judgement).

Trust really is a big thing, for both parties. You have to hand your cat over to a stranger and trust that they know what they’re doing. They have to trust you to be a calm, logical, level-headed owner with reasonable expectations who will follow aftercare instructions and work with them if complications or issues arise.

Your current situation is unfortunate and I’m sorry it’s so stressful for you. I’m not at all surprised the clinic held their ground on the cancelled surgery. Even if you asked point blank “what will it take for you to reconsider your decision,” sometimes it’s too late.

So, I’d suggest you try to reconnect with the other clinic. Consider that perhaps the “patronizing lectures” and “scolding” aren’t really intended as such, but perhaps a sign that they want to help Jessi and all of the “analysis paralysis” is impeding forward progress.

We all want to do right by our cats, but please, please remind yourself that you can’t know everything. Sometimes there are no “right” answers, just better and worse ones. And sometimes, once you’ve asked questions and tried to become informed, you just have to trust the vets who are guiding you, scary as it can be.

I too had a cat with SCC, but hers was the multicentric form (Bowen’s disease), so somewhat of a different beast.

I always look for “showstoppers” when evaluating whether to put a cat through significant surgery or treatment. What I mean by that, generally, is that I’m looking to see if there’s another serious issue that changes the calculus. I’m guessing that’s at least partly why your vet wanted the X-ray and ultrasound — not only would that potentially show metastasis to other organs, but it would help determine whether surgery should still be on the table and, if so, how aggressive to be.

Knowledge is power, and getting the data about what you’re dealing with gives the best chance at success.

For what it’s worth, if it were my cat, I’d have done X-ray/ultrasound/bloodwork to get as much data as possible; opted for a fine-needle aspirate and/or biopsy of the mass as well as the local lymph nodes if recommended (knowing full well that a clean result doesn’t guarantee there’s no cancer in the lymph nodes because the cancer cells can be microscopic and the needle might have simply “missed” finding them), and, if all looked good, scheduled surgical removal of the cancerous mass on the neck. I’d have asked questions about the pros/cons/logic of a CT scan as that’s not commonly done around here (and I’d have wanted to know what difference the results would make in treatment). I’d personally want that darned cancer completely out of there so would ask the vet how reasonable it is to achieve that goal and how to best make that happen. I’d hope they would take wide margins if that’s what is necessary and yes, I’d certainly allow them to take the local lymph nodes. I want to put my cat through this once and be done, hopefully coming home with a cured cat. Cancer is just too insidious to take partial or baby steps, at least IMHO.

The long-term benefit warrants the temporary stress/discomfort. Cats don’t like change and we often worry about their “stress” level in these things, but sometimes they handle it better than we do.

Best wishes.

 

[Veronica & Babu-chiri]

Stefania I got to apologize for not answering before and for taking so long to do it, I had some problems with my 17 year old girl so I was off line.

I'm sorry to hear all you are going through hearing that the surgery got canceled is really bad news but on the other end, whatever the real reason the clinic had to cancel it you are probably better off because if they were not sure they could give your cat the proper care is better for both of you to get the treatment elsewhere, specially if they think there’s no point for the treatment any more, that’s not the attitude you want, you need a vet that is willing to fight for Jessi even if the case is difficult but this means that you will probably will have to compromise a bit and endure the vets attitude I know my vet’s attitude is not the best my brother in law just hates him but he’s good and willing to work with Babu and my other cats ( none of which are easy cases) so I endure.


And yes dealing with vets is not an easy thing to do, but we do need them and their expertise so sometimes we just have to suck it up and be patient, I know that well since there are very limited options where I live so sometimes you just have to accept that even though is not exactly what you want it may be your only option specially with difficult cases there is usually not a really good option, sometimes not even a fairly good one there are bad or worse options sometimes and you just have to go for the least bad one and hope for the better.


Unfortunately I think medicine (human or non human) is probably the least scientific of the sciences because there is so much we as humanity don't know of how the body reacts, needs and works that vets even the beset ones that have lots of studies and degrees have to go for experience and their educated guess a lot of times and that is nerve racking to say the least.


You asked about the CT, I don’t know if I would have done one if the option would have been available because it usually requires anesthesia since you can’t really tell the cat not to move while the CT scanner is working and there’s no restraining them and given Babu’s age and CKD that is not a good idea, but it wasn’t available so we didn’t even consider it, the vet had to go with X rays and ultrasound which we did to have as much information as possible and the vet thought it was enough even if they would have to review the area once they cut open.


Regarding how much to take out given the place of Babu’s tumor, his forefront, to be honest there wasn’t much area to work with so the surgeon and the oncologist just forgot about radius and all that theory and went with as much as possible to try and make sure all the “bad” cells were removed ( this is one example where we had to rely on the vets expertise to do their best)


I hope some of this helps and know we are here for you please keep us updated on how is everything going

 

[Stefania S]

What in the world?? I can’t imagine that anyone who speaks in such a way could possibly love an animal. So, so callous and heartless.
And what a way to flip the attitude they showed earlier.

So a month ago the assessment was that it hasn’t spread to the other organs but now there’s a probability that it has? I know things can change anytime but this was totally said with no other intention than to cause you hurt and worry during a time when you’re already so down. What a bunch of sadists.

I’m sorry I suggested that you try to ask them to reconsider, without thinking that you would have done anything in your power to do so already.

And it sucks that the vets at the university are using this to push you into a corner. Why are they all on a power trip?


I wish you and I lived in the same side of the world so that I could help you better with finding out a good vet for Jessi.
Since it’s been more than a month since the SCC diagnosis, I assume you would now stick with the university vets for the surgery? I hope the university doesn’t add more delays since you’d said things move slowly there.

I’m constantly hoping and praying for the best for you and Jessi. I hope you can get over this soon. I know it’s a very difficult and painful day for you, but today’s the time to think of positive outcomes only for you and Jessi. This too shall pass.

THanks Nimi, it's ok, you couldn't know. Several other people told me to see if they would change their minds. I did try asking them what would make them change their minds. I think they wanted me to say the words 'I trust you completely, do whatever you need to do' and I just couldn't bring myself to say that. It's hard for me to lie. And it feels so wrong to let them decide everything.

Power trip is exactly the right expression in both cases.

Thanks as always for your caring and support! That helps a lot! I also wish there was someone directly in my life to shoulder some of the responsibility with me. But it is what it is. I got some new information today, a third opinion from a Vet outside of Bologna that was shockingly eye opening. I will post in another reply.

 

[Veronica & Babu-chiri]

THanks Nimi, it's ok, you couldn't know. Several other people told me to see if they would change their minds. I did try asking them what would make them change their minds. I think they wanted me to say the words 'I trust you completely, do whatever you need to do' and I just couldn't bring myself to say that. It's hard for me to lie. And it feels so wrong to let them decide everything.

Yes of course after all you are Jessi's mom so you have the right and need to have a say in what gets done that's even if you trust the vet and they hadn't earned your trust so I as I mentioned you are better off, hopefully the new vet you found would be the right option

Let us know how it goes

 

[Stefania S]

the indirect message is I need to

Yes of course after all you are Jessi's mom so you have the right and need to have a say in what gets done that's even if you trust the vet and they hadn't earned your trust so I as I mentioned you are better off, hopefully the new vet you found would be the right option

Let us know how it goes

Thanks for your understanding, Veronica. It's unfortunately not a new vet, it's the one from before and it's driving me crazy trying to decide if to go back to them or go another route entirely.

I better stop writing on this thread. It's awkward because I want to answer replies here but if I do that this thread keeps getting longer and people could be getting annoyed sooo...sorry for not getting back to you all. Other than a lack of time and energy right now, I have to either close this thread or start a new one or both. And I don't even know if starting a new one as a continuation of this one is ok. I was waiting for advice on that. I guess I'll just start a new one. So see you over there friends, for whoever wants to keep following and supporting us!

You are the best! Thanks so much!